99Tcm-DTPA Renal Dynamic Imaging Research Articles

Optimal assessment of the glomerular filtration rate in older chinese patients using the equations of the Berlin Initiative Study

AimTo evaluate the performances of the various estimated glomerular filtration rate (eGFR) equations of the Chronic Kidney Disease Epidemiology Collaboration, the Berlin Initiative Study (BIS), and the Full Age Spectrum (FAS) in older Chinese.MethodsThis study enrolled Chinese adults aged ≥ 65 years who underwent GFR measurements (via 99Tcm-DTPA renal dynamic imaging) in our hospital from 2011 to 2022. Using the measured glomerular filtration rate (mGFR) as the reference, we derived the bias, precision, accuracy, and consistency of each equation.ResultsWe enrolled 519 participants, comprising 155 with mGFR ≥ 60 mL/min/1.73 m2 and 364 with mGFR < 60 mL/min/1.73 m2. In the total patients, the BIS equation based on creatinine and cystatin C (BIScr-cys) exhibited the lowest bias [median (95% confidence interval): 1.61 (0.77–2.18)], highest precision [interquartile range 11.82 (10.32–13.70)], highest accuracy (P30: 81.12%), and best consistency (95% limit of agreement: 101.5 mL/min/1.73 m2). In the mGFR ≥ 60 mL/min/1.73 m2 subgroup, the BIScr-cys and FAS equation based on creatinine and cystatin C (FAScr-cys) performed better than the other equations; in the mGFR < 60 mL/min/1.73 m2 subgroup, all equations exhibited relatively large deviations from the mGFR. Of all eight equations, the BIScr-cys performed the best.ConclusionsAlthough no equation was fully accurate in the mGFR < 60 mL/min/1.73 m2 subgroup, the BIScr-cys (of the eight equations) assessed the eGFRs of the entire population best. A new equation is urgently required for older Chinese and even East Asians, especially those with moderate-to-severe renal insufficiency.

Choosing an appropriate glomerular filtration rate estimating equation: role of body mass index

BackgroundWe aimed to investigate the accuracy of different equations in evaluating estimated glomerular filtration rate (eGFR) in a Chinese population with different BMI levels.MethodsA total of 837 Chinese patients were enrolled, and the eGFRs were calculated by three Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, three full-age spectrum (FAS) equations and two Modification of Diet in Renal Disease (MDRD) equations. Results of measured GFR (mGFR) by the 99Tcm-diathylenetriamine pentaacetic acid (99Tcm-DTPA) renal dynamic imaging method were the reference standards. According to BMI distribution, the patients were divided into three intervals: below 25th(BMIP25), 25th to 75th(BMIP25–75) and over 75th percentiles (BMIP75).ResultsThe medium BMI of the three BMI intervals were 20.9, 24.8 and 28.9 kg/m2, respectively. All deviations from mGFR (eGFR) were correlated with BMI (p < 0.05). The percentage of cases in which eGFR was within mGFR ±30% (P30) was used to represent the accuracy of each equation. Overall, eGFRFAS_Cr_CysC and eGFREPI_Cr_2009 performed similarly, showing the best agreement with mGFR among the eight equations in Bland-Altman analysis (biases: 4.1 and − 4.2 mL/min/1.73m2, respectively). In BMIP25 interval, eGFRFAS_Cr got − 0.7 of the biases with 74.2% of P30, the kappa value was 0.422 in classification of CKD stages and the AUC60 was 0.928 in predicting renal insufficiency, and eGFREPI_Cr_2009 got 2.3 of the biases with 71.8% of P30, the kappa value was 0.418 in classification of CKD stages and the AUC60 was 0.920 in predicting renal insufficiency. In BMIP25–75 interval, the bias of eGFRFAS_Cr_CysC was 4.0 with 85.0% of P30, the kappa value was 0.501 and the AUC60 was 0.941, and eGFRFAS_Cr_CysC showed balanced recognition ability of each stage of CKD (62.3, 63.7, 68.0, 71.4 and 83.3% respectively). In BMIP75 interval, the bias of eGFREPI_Cr_CysC_2012 was 3.8 with 78.9% of P30, the kappa value was 0.484 the AUC60 was 0.919, and eGFREPI_Cr_CysC_2012 equation showed balanced and accurate recognition ability of each stage (60.5, 60.0, 71.4, 57.1 and 100% respectively). In BMIP75 interval, the bias of eGFRFAS_Cr_CysC was − 1.8 with 78.5% of P30, the kappa value was 0.485, the AUC60 was 0.922. However, the recognition ability of each stage of eGFRFAS_Cr_CysC eq. (71.1, 61.2, 70.0, 42.9 and 50.0% respectively) was not as good as GFREPI_Cr_CysC_2012 equation.ConclusionFor a Chinese population, we tend to recommend choosing eGFRFAS_Cr and eGFREPI_Cr_2009 when BMI was around 20.9, eGFRFAS_Cr_CysC when BMI was near 24.8, and eGFREPI_Cr_CysC_2012 when BMI was about 28.9.

Comparison of the relative renal function evaluated by 99Tcm-DMSA and 99Tcm-DTPA imaging in children with acute urinary tract infection

Objective To compare the relative renal function (RRF) evaluated by 99Tcm-dimercaptosuccinic acid (DMSA) and 99Tcm-diethylene triamine pentaacetic acid (DTPA) imaging in children with acute urinary tract infection (UTI). Methods A total of 69 children (29 males, 40 females, age: (45±38) months; duration of disease: <6 months) with acute UTI diagnosed clinically in Wuxi People′s Hospital from January 2017 to June 2019 were enrolled retrospectively. All children underwent 99Tcm-DMSA renal static imaging and 99Tcm-DTPA renal dynamic imaging, and the regions of interest (ROI) were drawn manually to calculate the RRF of the right and left kidneys. The consistency of RRF evaluated by the two imaging methods was analyzed by Bland-Altman analysis, the correlation was analyzed by Pearson correlation analysis, and the difference was compared by the independent-sample t test. Results The values of RRF measured with 99Tcm-DMSA and 99Tcm-DTPA were (52.27±14.53)% and (52.22±14.14)% for the left kidney (t=0.913, P>0.05), those for the right kidney were (47.73±14.53)% and (47.78±14.14)% (t=0.913, P>0.05), respectively. A significant positive correlation was found between the RRF measured with the two imaging methods both for left and right kidneys (r values: 0.959, 0.959; both P<0.01). Bland-Altman analysis showed that the average difference of RRF measured with the two imaging methods for left kidney was 0.1% and the 95% limits of agreement (LoA) was from -8.0% to 8.1%, those for right kidney were -0.1% and from -8.1% to 8.0%. Conclusions There is a good correlation between RRF measured with 99Tcm-DMSA renal static imaging and that measured with 99Tcm-DTPA renal dynamic imaging in children with acute UTI. Both imaging methods can be used to evaluate the RRF in children with acute UTI. Key words: Urinary tract infections; Infant; Child; Radionuclide imaging; Technetium Tc 99m dimercaptosuccinic acid; Technetium Tc 99m pentetate

99Tcm-DTPA renal dynamic imaging for detecting renal function before liver transplantation and predicting early acute kidney injury postoperation

Objective To investigate the value of 99Tcm-diethylene triamine pentoacetic acid (DTPA) renal dynamic imaging for detecting renal function before liver transplantation and predicting early acute kidney injury (AKI) postoperation. Methods A total of 40 patients (29 males, 11 females, average age (45±8) years) with end-stage liver diseases who underwent orthotopic liver transplantation from June 2015 to June 2016 were selected in this retrospective study. All patients underwent 99Tcm-DTPA renal dynamic imaging within one week before liver transplantation, the general glomerular filtration rate (GFR) and normalized GFR (NGFR) were calculated. The serum creatinine (SCr) and blood urea were detected during the perioperative period. Patients were divided into AKI group (n=15) and non-AKI group (n=25) according to whether the patients suffered from AKI 3 d after liver transplantation. The general GFR, NGFR, SCr and blood urea between two groups were compared using two-sample t test. The sensitivities and specificities of general GFR and NGFR for predicting AKI were evaluated by receiver operating characteristic (ROC) curve. Correlations between general GFR, NGFR and SCr, blood urea before liver transplantation were investigated by Pearson correlation analysis. Results The general GFR, NGFR before operation in AKI group were significantly lower than those in non-AKI group: (58.6±7.7) ml/min vs (77.3±12.3) ml/min, (57.7±7.5) ml·min-1·1.73 m-2vs (76.8±12.6) ml·min-1·1.73 m-2 (t values: -5.924, -5.981, both P 0.05). The area under curve (AUC) of general GFR and NGFR was 0.947 and 0.944, respectively. The early AKI was predicted by general GFR and NGFR under the cut-off<60 ml/min and <60 ml·min-1·1.73 m-2 with sensitivities of 9/15, 10/15 and specificities both of 96.0%(24/25). There were negative correlations between the general GFR and SCr, general GFR and blood urea, NGFR and SCr, NGFR and blood urea (r values: -0.555, -0.391, -0.562, -0.390, all P<0.05). Conclusions 99Tcm-DTPA renal dynamic imaging is helpful for the early detection of potential injury of the renal function. Both general GFR and NGFR could be the accurate indicators for predicting early AKI following orthotopic liver transplantation. Key words: End stage liver diseases; Liver transplantation; Acute kidney injury; Radionuclide imaging; Technetium Tc 99m pentetate

CKD-EPI creatinine-cystatin C glomerular filtration rate estimation equation seems more suitable for Chinese patients with chronic kidney disease than other equations

BackgroundThe aim of this study was to identify the optimal equation that accurately estimates the glomerular filtration rate (GFR) and the chronic kidney disease (CKD) stage in the Chinese population.MethodsA total of 1296 Chinese patients aged 18–65 years old were enrolled in this study. The estimated GFRs (eGFRs) calculated separately by three Diet in Renal Disease (MDRD) equations and three Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations were compared with the reference GFR (rGFR) measured by the 99Tcm-DTPA renal dynamic imaging method.ResultsBy Bland-Altman analysis, eGFRcys and eGFRscr_cys performed similarly, showing the tightest limits of agreement among the six equations. They also achieved the first and second highest 30% and 50% accuracies. Using a combination of the serum creatinine and cystatin C levels (eGFRscr_cys) could improve the bias (−0.3 for eGFRscr_cys) of the equation and achieve the highest diagnostic accuracy for renal insufficiency (AUC60, 0.953; P < 0.05, except for eGFR_MDRD). All equations predicted stage 3 CKD with moderate accuracy (49.7–51.4%) and stage 5 CKD with good accuracy (90.2–96.4%). For stage 1 CKD, eGFRcys showed a higher percentage of misclassification than the other equations. All equations seemed to perform poorly at predicting stage 2 and 4 CKD, as compared to the other CKD stages. eGFRscr_cys was the best-performing equation in terms of accurate classification of the CKD stage based on the overall performance (kappa value, 0.423).ConclusionFor a Chinese population, the CKD-EPIscr_cys equation seems more suitable for estimating the GFR than the other equations. Each equation had its own advantages in predicting different CKD stages.

Diagnostic value of glomerular filtration rate, microalbuminuria, β2-microglobulin and cystatin C for renal function in patients with diabetic nephropathy

Objective To investigate the clinical value of GFR, microalbuminuria (mAlb), serum β2-microglobulin (MG) and cystatin C (CysC) for the evaluation of renal function in patients with DN. Methods A total of 150 patients with type 2 DM diagnosed by WHO standard (1999) from December 2012 to December 2015 were retrospectively analyzed. Thirty-three kidney transplantation donors during the same time were chosen as the control group. The urine mAlb, Cr, albumin/Cr ratio(ACR) and SCr, serum β2-MG, CysC, urea, uric acid(UA), fasting blood glucose (FBG), hemoglobin A lc (HbA1c) and C-reactive protein (CRP) were measured. 99Tcm-DTPA renal dynamic imaging was performed. The Gates method was used to calculate GFR, and the modification of diet in renal disease (MDRD) method was used to calculate the estimated GFR (eGFR). The relative equation between GFR and eGFR was studied. The clinical stages of renal function in type 2 DM patients were evaluated by Mogenesen standard method. Two-sample t test was used for data analysis. ROC curve analysis was performed to study the diagnostic value of GFR in DN. Results The patients were divided into merely type 2 DM group, early stage DN (Ⅰ, Ⅱ, Ⅲ), and clinical DN(Ⅳ) groups by Mogenesen standard method. GFR and eGFR in the DNⅠstage were higher than those of the merely type 2 DM group (t values: -7.502, -3.629, both P 0.05), but the renal function indicators were different (t values: -5.090-2.209, all P<0.01). Compared with the normal CRP group, the FBG, HbA1c and renal function indicators were statistically different in high CRP group (t values: -6.114-7.386, all P<0.01). Conclusions GFR and eGFR show a linear relationship in type 2 DM. GFR is a sensitive, specific diagnostic index in DN Ⅰ period. β2-MG, CysC, mAlb and ACR are conducive to the early diagnosis of DN. High UA is an independent risk factor for the onset of DN, and high CRP is an inflammatory damage factor in DN. Key words: Diabetic nephropathies; Glomerular filtration rate; Albumins; beta 2-Microglobulin; Cystatin C