Iohexol Plasma Research Articles

The Role of Cystatin C in Improving GFR Estimation in the General Population

The equations used to estimate glomerular filtration rate (GFR) based on serum creatinine level are limited by their dependence on muscle mass. Although cystatin C level predicts clinical outcomes better than creatinine level in the general population, its role in estimating GFR in the reference range is unclear. Cystatin C level is not influenced by muscle mass, but by several other non-GFR determinants. We investigated whether regression models using cystatin C level alone or in combination with creatinine level in principle would improve GFR estimation in the general population compared with models using creatinine level alone. Study of diagnostic accuracy. A representative sample (n = 1,621; aged 50-62 years) of the general population in Tromsø, Norway, without coronary heart disease, stroke, diabetes mellitus, or kidney disease. Individuals had participated in the Renal Iohexol Clearance Survey (RENIS-T6), part of the sixth Tromsø Study. Performance of multiple linear and fractional polynomial regression models with plasma creatinine and/or cystatin C levels as independent variables and measured GFR as a dependent variable. Plasma iohexol clearance. Creatinine measured with an enzymatic method. Cystatin C measured with a particle-enhanced turbidimetric immunoassay. In internal validation of models with cystatin C, creatinine, or both levels, percentages of GFR estimates within 10% of measured GFR were 61% (95% CI, 58%-63%), 62% (95% CI, 59%-64%), and 68% (95% CI, 65%-70%), respectively. Models with either cystatin C or creatinine level had very similar precision and ability to detect GFR <90 mL/min/1.73 m(2), whereas models based on both markers performed better. Only middle-aged individuals of European ancestry were investigated. Lack of standardization between cystatin C assays. No external validation of regression models. Models based on cystatin C alone are not superior to those based on creatinine, but models based on both markers can improve GFR estimation in the reference range.

Comparative study between trimetazidine and ice slush hypothermia in protection against renal ischemia/reperfusion injury in a porcine model

The aim of the study was to compare the effects of renal ice slush hypothermia and the use of trimetazidine in the protection against ischemia/reperfusion (I/R) injury. Fifteen farm pigs were submitted to left kidney ischemia and right nephrectomy during the same procedure. Animals were divided into three groups. Group 1 was submitted to warm ischemia; Group 2 was submitted to cold ischemia with ice slush; and Group 3 received trimetazidine 20 mg one day and 4 hours before surgery. Ischemia time was 120 minutes in all three groups. Serum creatinine (SCr) and plasma iohexol clearance (CLioh) were measured before surgery and on postoperative days (PODs) 1,3,7, and 14. Semi-quantitative analyses of histological alterations were performed by a pathologist. A p value of < 0.05 was considered significant. All groups showed elevation of serum creatinine in the first week. Serum creatinine was higher in Group 3 in the first and third postoperative days (Mean Cr: 5.5 and 8.1 respectively). Group 2 showed a lower increase in creatinine and a lower decrease in iohexol clearance than the others. Renal function stabilized in the fourteenth POD in all three groups. Analyses of histological alterations did not reach statistical significance between groups. Trimetazidine did not show protection against renal I/R injury in comparison to warm ischemia or hypothermia in a porcine model submitted to 120 minutes of renal ischemia.

Urological Disorders in Chronic Kidney Disease in Children Cohort: Clinical Characteristics and Estimation of Glomerular Filtration Rate

Urological disorders are the most common cause of pediatric chronic kidney disease. We determined the characteristics of children with urological disorders and assessed the agreement between the newly developed bedside glomerular filtration rate estimating formula with measured glomerular filtration rate in 586 patients in the Chronic Kidney Disease in Children study. The Chronic Kidney Disease in Children study is a prospective, observational cohort of children recruited from 48 sites in the United States and Canada. Eligibility requirements include age 1 to 16 years and estimated glomerular filtration rate by original Schwartz formula 30 to 90 ml/min/1.73 m(2). Baseline demographics, clinical variables and glomerular filtration rate were assessed. Bland-Altman analysis was conducted to assess agreement between estimated and measured glomerular filtration rates. Of the 586 participants with at least 1 glomerular filtration rate measurement 348 (59%) had an underlying urological diagnosis (obstructive uropathy in 118, aplastic/hypoplastic/dysplastic kidneys in 104, reflux in 87 and other condition in 39). Among these patients median age was 9 years, duration of chronic kidney disease was 7 years and age at first visit with a urologist was less than 1 year. Of the patients 67% were male, 67% were white and 21% had a low birth weight. Median height was in the 24th percentile. Median glomerular filtration rate as measured by iohexol plasma disappearance was 44.8 ml/min/1.73 m(2). Median glomerular filtration rate as estimated by the Chronic Kidney Disease in Children bedside equation was 44.3 ml/min/1.73 m(2) (bias = -0.5, 95% CI -1.7 to 0.7, p = 0.44). Underlying urological causes of chronic kidney disease were present in 59% of study participants. These children were diagnosed early in life, and many had low birth weight and growth delay. There is good agreement between the newly developed Chronic Kidney Disease in Children estimating equations and measured glomerular filtration rate in this population.

Universal GFR determination based on two time points during plasma iohexol disappearance

An optimal measurement of glomerular filtration rate (GFR) should minimize the number of blood draws, and reduce procedural invasiveness and the burden to study personnel and cost, without sacrificing accuracy. Equations have been proposed to calculate GFR from the slow compartment separately for adults and children. To develop a universal equation, we used 1347 GFR measurements from two diverse groups consisting of 527 men in the Multicenter AIDS Cohort Study and 514 children in the Chronic Kidney Disease in Children cohort. Both studies used nearly identical two-compartment (fast and slow) protocols to measure GFR. To estimate the fast component from markers of body size and of the slow component, we used standard linear regression methods with the log-transformed fast area as the dependent variable. The fast area could be accurately estimated from body surface area by a simple parameter (6.4/body surface area) with no residual dependence on the slow area or other markers of body size. Our equation measures only the slow iohexol plasma disappearance curve with as few as two time points and was normalized to 1.73 m2 body surface area. It is of the form: GFR=slowGFR/[1+0.12(slowGFR/100)]. In a random sample utilizing a third of the patients for validation, there was excellent agreement between the calculated and measured GFR with low root mean square errors being 4.6 and 1.5 ml/min per 1.73 m2 for adults and children, respectively. Thus, our proposed simple equation, developed in a combined patient group with a broad range of GFRs, may be applied universally and is independent of the injected amount of iohexol.

Impaired Fasting Glucose Is Associated With Renal Hyperfiltration in the General Population

OBJECTIVEIncreased glomerular filtration rate (GFR), also called hyperfiltration, is a proposed mechanism for renal injury in diabetes. The causes of hyperfiltration in individuals without diabetes are largely unknown, including the possible role of borderline hyperglycemia. We assessed whether impaired fasting glucose (IFG; 5.6–6.9 mmol/L), elevated HbA1c, or hyperinsulinemia are associated with hyperfiltration in the general middle-aged population.RESEARCH DESIGN AND METHODSA total of 1,560 individuals, aged 50–62 years without diabetes, were included in the Renal Iohexol Clearance Survey in Tromsø 6 (RENIS-T6). GFR was measured as single-sample plasma iohexol clearance. Hyperfiltration was defined as GFR >90th percentile, adjusted for sex, age, weight, height, and use of renin-angiotensin system inhibitors.RESULTSParticipants with IFG had a multivariable-adjusted odds ratio of 1.56 (95% CI 1.07–2.25) for hyperfiltration compared with individuals with normal fasting glucose. Odds ratios (95% CI) of hyperfiltration calculated for a 1-unit increase in fasting plasma glucose (FPG) and HbA1c, after multivariable-adjustment, were 1.97 (1.36–2.85) and 2.23 (1.30–3.86). There was no association between fasting insulin levels and hyperfiltration. A nonlinear association between FPG and GFR was observed (df = 3, P < 0.0001). GFR increased with higher glucose levels, with a steeper slope beginning at FPG ≥5.4 mmol/L.CONCLUSIONSBorderline hyperglycemia was associated with hyperfiltration, whereas hyperinsulinemia was not. Longitudinal studies are needed to investigate whether the hyperfiltration associated with IFG is a risk factor for renal injury in the general population.

Extracellular volume in children with chronic kidney disease

In the CKiD study, extracellular fluid volume (ECV) was estimated from plasma iohexol curves in children with chronic kidney disease. A simple formula for ECV that uses weight and height data has now been derived. No relationship existed between weight-normalized ECV and hypertension, suggesting that volume overload does not underlie hypertension in this population.

Evaluation of Sample Bias for Measuring Plasma Iohexol Clearance in Kidney Transplantation

Plasma clearance of iohexol (PCI) is becoming a commonly used standard tool in many clinical trials to evaluate the glomerular filtration rate (GFR). However, most studies performing PCI use only early plasma samples (2, 3, and 4 hr). This study aims to evaluate the role of early and late plasma sampling in the precision of PCI calculation in transplant recipients. We evaluated 342 renal transplant recipients for both renal clearance (RC) and plasma clearance, using iohexol and six blood samples (2, 3, 4, 5, 6, and 24 hr). Patients were divided into three subgroups according to RC: <30, 30 to 60, and >60 mL/min/1.75 m(2). A simplified technique using early plasma samples overestimated GFR with a mean difference between plasma clearance and RC of 53.3%, 25.7%, and 12.5% for the three subgroups, respectively. This difference decreased to 8.8%, 6.3%, and 5.5%, respectively, when the 24-hr sample was included in plasma clearance calculation. These results demonstrate that GFR evaluation by PCI in renal transplant recipients requires a late plasma sample.

Rapid LC-UV Analysis of Iohexol in Canine Plasma for Glomerular Filtration Rate Determination

A rapid high-performance liquid chromatography UV method and a simple sample preparation for analyzing iohexol in canine plasma, for evaluating glomerular filtration rate (GFR) and intestinal permeability, were developed and validated. Trifluoroacetic acid (TFA) was used for protein precipitation and iohexol extraction from plasma, followed by vortex mixing and centrifugation. As an internal standard, 4-aminobenzoic acid (para-aminobenzoic acid, PABA) was added. The supernatant (5 μL) was injected into a Zorbax SB-C18 LC column maintained at 50 °C. The mobile phase of the LC method was a water–methanol gradient at pH 3.0 adjusted with TFA. Fast LC measurement was achieved by using a rapid-resolution LC technique. Total run time was 13 min, and UV wavelength was set at 246 nm. Precision of the method was 0.2–9.0%, depending on the iohexol concentration in plasma. Recovery of iohexol from plasma was over 90%, and recovery of the internal standard 99.1 ± 1.4%. The calibration curve was linear (r = 0.9997) over iohexol concentrations of 2.5–150 μg mL−1 (n = 5). This method is fast, simple, reliable and applicable in clinical settings.

Standardized Protocols for Plasma Clearance of Iohexol are not Appropriate for Determination of Glomerular Filtration Rates in Anesthetized California Sea Lions (Zalophus californianus)

Abstract: Plasma clearance of iohexol was evaluated in eight anesthetized California sea lions (Zalophus californianus), without evidence of renal dysfunction, to determine if the one-compartment model and the sample protocol used in dogs and cats could be applied to this species. Nonlinearity between samples in 75% (6/8) of sea lions voided those results. An additional two anesthetized sea lions were sampled at 5, 30, 45, 60, 120, 180, 240, and 360 min post iohexol injection and semi-logarithmic curves calculated. Plasma iohexol clearance values calculated by one-, two-, and noncompartment models were in poor agreement, suggesting that the standardized protocol described for dogs and cats cannot simply be applied to California sea lions, probably due to the effects of the dive reflex induced during anesthesia.

Assessments of Factors that Affect Glomerular Filtration Rate and Indirect Markers of Renal Function in Dogs and Cats

Chronic kidney disease is one of the most common disorders in dogs and cats. The plasma urea nitrogen (P-UN) and creatinine (P-Cre) concentrations are not sufficiently sensitive for early diagnosis of renal dysfunction. Although urine and plasma clearance methods allow earlier detection of reductions in the GFR, it is difficult to estimate a mildly reduced GFR from the values obtained by these methods, as they are also affected by physiological factors, such as body weight (BW) and age. The present study is a retrospective survey designed to assess the factors that affect markers of kidney function and to revaluate the clinical utility of the markers, including P-UN, P-Cre and GFR determined by plasma iohexol clearance (PCio) in dogs and cats. The P-UN, P-Cre and PCio values in dogs and the P-Cre and PCio values in cats were significantly correlated with BW (P<0.001). PCio in smaller dogs (≤ 15.0 kg) was significantly and inversely correlated with age. In smaller dogs, increase of P-UN alone might warrant a suspicion of a decreased GFR, but in contrast, P-Cre may be inefficient for detecting renal dysfunction or determining the severity of CKD compared with that in larger dogs (≥ 15.1 kg). P-Cre in larger dogs correlated better with PCio than in smaller dogs, suggesting that P-Cre in larger dogs was a more sensitive marker of reduced GFR.

Evaluation of a Single Sampling Method for Estimation of Plasma Iohexol Clearance in Dogs and Cats with Various Kidney Functions

Plasma iohexol clearance (PCio) is a practical method for measuring the glomerular filtration rate (GFR) in clinical settings. However, it is too time-consuming for routine application and requires hospitalization for at least half a day. Therefore, the development of a simpler procedure for plasma clearance is necessary to allow the frequent measurement of GFR in clinical settings. The purpose of the present study was to evaluate a single sampling method for estimation of PCio in dogs and cats with various kidney functions. The PCio determined by the 1-compartment model using 3 samples (PCio (3samples)) was used as a reference for the evaluation of the single sampling method (PCio (single)). Plasma iohexol concentration was determined by a cerium arsenite colorimetric method. PCio single was calculated using the equation obtained by nonlinear regression analysis. PCio (single) was significantly correlated with PCio (3samples) in both dogs and cats (dogs: R(2)=0.985, P<0.001, cats: R(2)=0.986, P<0.001). In a receiver operating characteristics analysis, the area under the curve, sensitivity, and specificity for detecting decreased GFR were 0.995 [SE, 0.003], 98%, and 93% for dogs and 0.993 [SE, 0.003], 98%, and 93% for cats, respectively. These results demonstrate that PCio (single) may be very useful for the detection of decreasing GFR in dogs and cats.

Effects of meloxicam on plasma iohexol clearance as a marker of glomerular filtration rate in conscious healthy cats

To investigate the effect of therapeutic dosages of meloxicam on the plasma clearance of iohexol in healthy, euvolemic, conscious cats fed a sodium-replete diet. 6 healthy adult neutered male cats. For each treatment period in a masked, randomized, crossover study, cats were administered either no treatment or meloxicam. Iohexol clearance studies were performed before the treatment period began (baseline) and on the final day of the treatment period. Iohexol concentrations were determined by use of a high-performance liquid chromatography assay, and plasma iohexol clearance as a marker of glomerular filtration rate was calculated by use of a 1-compartment model. No significant treatment effect was detected. Mean +/- SE iohexol clearance for cats administered meloxicam (3.31 +/- 0.27 mL/min/kg) was not significantly different from mean baseline value for the meloxicam treatment period (3.07 +/- 0.32 mL/min/kg). In this study, short-term meloxicam administration did not measurably alter the glomerular filtration rate as assessed via plasma clearance of iohexol. This suggests that renal prostaglandins in cats did not have a measurable effect on glomerular filtration rates in healthy, euvolemic, conscious states as determined on the basis of methods used in this study.

Adipocytokines are associated with renal function in patients with normal range glomerular filtration rate and type 2 diabetes

Introduction Adipocytokines represent a molecular link between metabolic factors and vascular function. The purpose of our study was to investigate the relationship between adiponectin, leptin and renal function parameters in patients with glomerular filtration rate (GFR) above 90 ml/min/m 2 and type 2 diabetes. Materials and methods: In 52 patients, plasma (P-) and urinary (U-) adiponectin and leptin were determined by radioimmunoassay and ELISA, respectively. Kidney function was assessed with GFR (plasma iohexol clearance) and albuminuria (radioimmunoassay). Results: The patients were aged 58 ± 8 years and had a mean BMI value of 31.2 ± 5.2 kg/m 2. Our measurements yielded the following values, expressed as median (25th percentile, 75th percentile): P-adiponectin 11.0 (7.1, 14.5) μg/ml, P-leptin 20.7 (9.6, 35.9) ng/ml, U-adiponectin 0.8 (0.3, 1.2) μg/mg creatinine, and U-leptin 1.0 (0.4, 1.9) μg/mg creatinine. Albuminuria correlated with P-adiponectin ( R = −0.31, p = 0.03), and GFR correlated with U-leptin ( R = −0.32, p = 0.04). Conclusions: Adiponectin and leptin are associated with parameters of renal function already at the stage of apparently normal kidney function in type 2 diabetes. The exact mechanisms of the adipocyte–vasculature axis still remain to be elucidated.

Evaluation of the Measurement of Serum Cystatin C by an Enzyme-Linked Immunosorbent Assay for Humans as a Marker of the Glomerular Filtration Rate in Dogs

The serum cystatin C (Cys-C) concentration is a better filtration marker than plasma creatinine (Cre) concentration in humans. In veterinary medicine, a few studies have shown that the serum Cys-C concentration in dogs is also a better marker than the plasma Cre concentration. The purpose of this study is to evaluate the applicability of measuring the serum Cys-C concentration by an enzyme-linked immunosorbent assay (ELISA) as a marker of the glomerular filtration rate in dogs with various renal dysfunctions. The serum Cys-C concentration in dogs with chronic kidney disease (CKD) was significantly higher (1.23 +/- 0.21 mg/L) than that in 76 control dogs (0.85 +/- 0.15) (P<0.001). The reference range of the serum Cys-C concentrations in samples from the 76 control dogs was 0.55-1.15 mg/l. Serum Cys-C concentration was more strongly correlated with plasma iohexol clearance (r=-0.704, P<0.001) than plasma Cre concentration in dogs (r=-0.598, P<0.001). In a receiver operating characteristics analysis, significant differences between the serum Cys-C and plasma Cre concentrations were found with regard to their AUC (0.949, [SE, 0.019] and 0.849 [SE, 0.029]) and diagnostic sensitivity (90.3% and 73.6%) for detecting decreased PCio (P<0.05). Therefore, the measurement of serum Cys-C concentration by ELISA is more useful for the detection of early CKD than measuring the plasma Cre concentration.

Glomerular filtration rate after tramadol, parecoxib and pindolol following anaesthesia and analgesia in comparison with morphine in dogs

ObjectiveTo compare the effects of morphine, parecoxib, tramadol and a combination of parecoxib, tramadol and pindolol on nociceptive thresholds in awake animals and their effect on glomerular filtration rate (GFR) in dogs subjected to 30 minutes of anesthesia. AnimalsEight adult mixed breed experimental dogs. Study designRandomized, controlled trial. MethodsDogs received 0.05 mg kg−1 acepromazine subcutaneously (SC) as anaesthetic pre-medication. Thirty to sixty minutes later, they received either tramadol 3 mg kg−1 intravenously, (IV), parecoxib (1 mg kg−1 IV), a combination of tramadol 3 mg kg−1 (IV), parecoxib 1 mg kg−1 (IV) and pindolol 5 μg kg−1 (SC), morphine (0.1 mg kg−1 (IV) or 0.9% saline (2 mL). Anaesthesia was then induced with IV propofol to effect (2.9 ± 0.8 mg kg−1) and maintained with halothane in oxygen for 30 minutes. Systolic arterial blood pressure was maintained above 90 mmHg with IV fluids and by adjusting the inspired halothane concentration. Post-treatment nociceptive thresholds to mechanical stimuli, expressed as percent of pre-treatment values, were compared between the treatments to assess the analgesic efficacy of the drugs. Plasma iohexol clearance (ICL), a measure of GFR, was estimated both before and 24 hours after induction of anaesthesia to study the drugs’ effects on renal perfusion. Nociceptive threshold and GFR data were compared using mixed model analysis in sas®9.1. ResultsBoth tramadol and parecoxib produced similar analgesia, which was less than that of morphine. Their combination with pindolol produced analgesia comparable with morphine. None of the test drugs, either alone or in combination, reduced GFR. ConclusionTramadol and parecoxib (either alone or in combination) can increase nociceptive thresholds in awake dogs and have minimal effects on renal perfusion in normotensive dogs subjected to anaesthesia.

Concentrations of moxifloxacin in plasma and urine, and penetration into prostatic fluid and ejaculate, following single oral administration of 400 mg to healthy volunteers

The spectrum of chronic bacterial prostatitis (CBP) comprises Gram-negative, Gram-positive and atypical pathogens. Because of its broad spectrum of activity, moxifloxacin might be a suitable antibiotic for the treatment of CBP. In this pharmacokinetic study, plasma concentrations and the penetration of moxifloxacin into prostatic fluid and ejaculate were investigated. Twelve healthy male volunteers received a single oral dose of 400 mg moxifloxacin and at the same time received 3.24 g of iohexol intravenously to assess urinary contamination of prostatic fluid and ejaculate. Plasma concentrations were determined at 0, 0.5, 1, 2, 3 and 4 h and prostatic fluid and ejaculate (mean ± standard deviation (S.D.)) were determined at 3.5 ± 0.4 h and 3.6 ± 0.4 h, respectively, following administration of drugs. Urinary concentrations were determined in the urine collected from 0–4.5 h. Concentrations of moxifloxacin and iohexol in plasma, secretions and urine were determined by high-performance liquid chromatography. The mean ± S.D. peak plasma concentration of moxifloxacin was 2.8 ± 0.5 mg/L observed after 1.6 ± 0.9 h. In prostatic fluid, the concentration of moxifloxacin was 3.8 ± 1.2 mg/L and the prostatic fluid/plasma ratio was 1.6 ± 0.5. In ejaculate, the concentration was 2.5 ± 0.7 mg/L and the ejaculate/plasma ratio was 1.0 ± 0.2. Moxifloxacin concentrations in prostatic fluid were ca. 60% ( P < 0.05) higher than in plasma and concentrations in ejaculate were approximately the same as in plasma. Therefore, moxifloxacin might be a good alternative for the treatment of CBP, but further studies are warranted to establish this indication.

Can plasma iohexol disappearance be used to measure GFR in children with chronic kidney disease?

Can plasma iohexol disappearance be used to measure GFR in children with chronic kidney disease?

Glomerular filtration rate via plasma iohexol disappearance: Pilot study for chronic kidney disease in children

To guide the design of a nation-wide cohort study of chronic kidney disease in children, we determined how iohexol plasma disappearance curves could be used in children to measure glomerular filtration rate (GFR). Iohexol (5 ml) was administered intravenously and blood samples were obtained at 10, 20, 30, 60, 120, 240, 300, and 360 min after injection (N=29) and assayed by high performance liquid chromatography. Four urines were also collected following the injection. Intra-assay coefficient of variation (CV) in serum was 1.3% at 100 mg/l, 2.6% at 15 mg/l, and 3.4% for duplicate unknowns. GFR(9) was computed from iohexol dose and area under the nine-point blood disappearance curve, using double exponential modeling. Only 2.8% of 254 data points deviated by >3 CV from the curves. GFR(4) calculated from 10, 30, 120, and 300 min points correlated well with GFR(9) (r=0.999) and showed no bias (means+/-s.d. of GFR(9) and GFR(4)=59.3+/-36.3 and 59.4+/-36.0 ml/min per 1.73 m(2)). Relationship of GFR(9) and one-compartment GFR followed quadratic equation as previously reported by Brochner-Mortensen, allowing GFR to be calculated from 120 and 300 min points. This GFR(2) correlated well with GFR(9) (r=0.986). Estimated GFR from Schwartz height/creatinine formula correlated with GFR(9)(r=0.934) but overestimated GFR by 12.2 ml/min per 1.73 m(2). Urine iohexol clearance was poorly correlated (r=0.770) with GFR(9) owing to variability in urine collections (median CV=24%). GFR can be measured accurately using four-point iohexol plasma disappearance (in most cases, two points suffice); estimated GFR and urinary clearances are less useful.

DETERMINATION OF GLOMERULAR FILTRATION RATE IN DOGS USING CONTRAST‐ENHANCED COMPUTED TOMOGRAPHY

The purpose of this project was to establish a procedure and reference values for glomerular filtration rate (GFR) using contrast-enhanced computed tomography (CT) in eight healthy dogs. A single section of the kidney was scanned sequentially after bolus injection (3 ml/s) of iohexol (300 mg/kg). Time-attenuation curves were constructed and the GFR per volume of kidney was calculated using Patlak graphical analysis software. The GFR was then converted from contrast clearance per unit volume (ml/min/ml) to contrast clearance per body weight (ml/min/kg). Individual kidney and global GFR were calculated using both CT and nuclear scintigraphy. Global GFR for each dog was also determined by plasma iohexol clearance. Contrast-enhanced CT underestimated the global GFR compared with the other two methods. The average global GFR was 2.57 +/- 0.33 ml/ min/kg using functional CT and 4.06 +/- 0.37 ml/min/kg using plasma iohexol clearance. There was significant (P < 0.05) interobserver variability of CT GFR of the right kidney and total GFR. There was decreased interobserver variability for the left kidney. There was no difference in the intraobserver variability for CT-determined individual kidney and global GFR. There was no difference between the motion corrected and nonmotion corrected values for individual and global CT GFR. Nuclear scintigraphy produced a slightly higher coefficient of variation than contrast-enhanced CT, 2.9% and 1.0%, respectively. It is hypothesized that altered renal blood flow, hematocrit of the small vessels, and nephrotoxicity play a role in the underestimation of GFR by contrast-enhanced CT.

Measuring the Size of the Extracellular Fluid Space Using Bromide, Iohexol, and Sodium Dilution

There is a need to find methods to assess the size of the extracellular fluid (ECF) volume without involving radioactive tracers. For this purpose, we applied 3 methods for measuring the ECF volume in 10 male volunteers (mean age, 34 yr). Steady-state plasma bromide concentration (control) was compared to the results of kinetic analysis of plasma iohexol and to kinetic analysis of the dilution of serum sodium after IV infusion of 1 L of isotonic mannitol. The volume of distribution of these tracers was used to indicate the ECF volume. The results disclosed statistically significant correlations between the results of all 3 methods, although the average sodium dilution showed 0.7 L lower values than iohexol and 1.4 L lower than bromide. All three methods correlated significantly with body weight. The percentage of the body weight indicated by the methods was 18.3% (3.1%) for sodium, 19.6% (1.0%) for iohexol, and 20.5% (1.1%) for bromide. We conclude that sodium dilution may be performed at bedside but iohexol and bromide showed less intersubject variability. Iohexol simultaneously measures the glomerular filtration rate and should be a viable clinical option if the hospital performs routine assessments of kidney function using this tracer.