Abstract
Glomerular filtration rate (GFR), 131I-Hippuran clearance and estimated creatinine clearance were investigated in 34 patients with cancer. For Hippuran clearance and GFR, analysed with the X-ray contrast (iohexol) and fluorescence technique, the least square linear regression coefficient was 5.01 +/- 0.41 (r = 0.91). This value concurs with the five to one ratio between GFR and renal plasma flow known from normal physiology and supports that Hippuran clearance is a valid measure of renal function. When the individual values of Hippuran clearance were divided by 5.01, the mean difference between the methods was 0.4 ml min-1 1.73 m-2 with standard deviation 13.4 ml min-1 1.73 m-2. The lower and upper limits of agreement were -26.7 and 25.9 ml min-1 1.73 m-2, respectively. Comparing creatinine clearance estimated from the serum creatinine level with GFR, the limits of agreement were -29.4 and 21.6 ml min-1 1.73 m-2. These agreement limits are in the same range as those which can be calculated from the data from other studies.
Highlights
The proportionality coefficient of 5.01 ± 0.41 between Hippuran clearance and Glomerular filtration rate (GFR) measured by iohexol fluorescence is close to this ratio and confirms the link between glomerular and tubular function embodied in the 'intact nephron hypothesis'
Creatinine clearance estimations based on the serum creatinine level is subject to the influence from the patient's muscle mass, physical activity and intake of cooked meat
The Hippuran clearance will underestimate kidney function in the presence of substances which compete with Hippuran for transport on the tubular level, for example cisplatin
Summary
Between November 1989 and April 1990, 35 consecutive cancer patients underwent investigations of glomerular filtration rate (GFR) using iohexol fluorescence technique, and Hippuran clearance. In one patient with testicular cancer, the blood samples for the Hippuran clearance measurement was contaminated with the radiotracer. This patient was excluded, leaving 34 patients for evaluation (Table I). All were normotensive without known glomerular disease and none had previously received cytotoxic therapy. None had serum creatinine levels >300g.moll1' (upper limit 125iLmollh'), clinical signs of oedema, ascites, or pleural effusion, or known allergic disorder. The protocol included two blood samples for serum creatinine measurement, one obtained concurrently with the GFR investigation and one obtained previously, usually on the day of admission.
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