Detection of impaired renal function

M. J. Reinhardt; H. Weidling; H.-P. Breuel; H.-J. Biersack

doi:10.1055/s-0038-1623917

Nuklearmedizin - NuclearMedicine, Inhaltsverzeichnis

Nuklearmedizin 2004; 43(06): 203-209
DOI: 10.1055/s-0038-1623917

Originalarbeiten – Original Articles

Schattauer GmbH

Detection of impaired renal function

Is the modern serologic marker cystatin C more accurate than the ^99mTc-MAG₃ clearance?Nachweis der eingeschränkten NierenfunktionIst der moderne serologische Marker Cystatin C der ^99mTc-MAG_3-Clearance überlegen?

M. J. Reinhardt

¹Klinik und Poliklinik für Nuklearmedizin (Leiter: Prof. Dr. H.-J. Biersack), Universitätsklinikum Bonn

,

H. Weidling

¹Klinik und Poliklinik für Nuklearmedizin (Leiter: Prof. Dr. H.-J. Biersack), Universitätsklinikum Bonn

,

H.-P. Breuel

¹Klinik und Poliklinik für Nuklearmedizin (Leiter: Prof. Dr. H.-J. Biersack), Universitätsklinikum Bonn

,

H.-J. Biersack

¹Klinik und Poliklinik für Nuklearmedizin (Leiter: Prof. Dr. H.-J. Biersack), Universitätsklinikum Bonn

› Institutsangaben

Abstract

Summary

Aim: Renal function is usually determined by means of creatinine-clearance, and of serum Cystatin C, the latter with increasing frequency. The present study analyses, whether the diagnostic accuracy of ^99mTc-MAG₃ clearance is comparable to that of these modern serologic methods. Patienten, Methods: 71 consecutive adult Caucasian patients (42 female, 29 male; age 50 ± 16 yrs., range 20 – 83) who were referred to a nuclear medicine department for determination of bilateral renal function with ^99mTc-MAG₃ were included. Following sufficient hydration, 10 ml of blood were taken for determination of Cystatin C and creatinine in serum prior to i.v. injection of the radiotracer. According to the recommendations of the National Kidney Foundation, glomerular filtration rate (GFR) was calculated from serum creatinine using either Cockcroft & Gault and Modification of Diet in Renal Disease (MDRD) study equation. These estimates of GFR served as reference. Cystatin C is a low molecular protein produced by all nuclear cells and is eliminated to 85 % by glomerular filtration. Analysis of ^99mTc-MAG₃ clearance was performed by means of Bubeck’s formula. Results: Linear regression analysis produced Pearson’s correlation coefficients of r = 0.68 and r = -0.69 for the comparison of either Cystatin C and ^99mTc-MAG₃ clearance with the Cockcroft & Gault equation. The comparison of Cystatin C and ^99mTc-MAG₃ clearance with MDRD study equation resulted in correlation coefficients of r = 0.755 and r = -0.77. None of these differences were significant. The exclusion of renal impairment or the detection of an at least moderate renal impairment revealed again no significant differences between Cystatin C and ^99mTc-MAG₃ clearance. Conclusions: Cystatin C and ^99mTc-MAG₃ clearance are equally suited to exclude renal impairment or to detect a relevant renal impairment. Differences between both procedures are more likely a result of the applied reference method.

Zusammenfassung

Ziel: Zur Beurteilung der Nierenfunktion wird, neben der Kreatinin-Clearance, zunehmend auch Cystatin C im Serum bestimmt. Die vorliegende Untersuchung geht der Frage nach, ob die nuklearmedizinische Clearance-Bestimmung mit ^99mTc-MAG₃ gegenüber den modernen serologischen Verfahren bestehen kann. Patienten, Methoden: Eingeschlossen wurden 71 konsekutive erwachsene kaukasische Patienten (42 Frauen, 29 Männer; Alter: 50 ± 16 Jahre), die zu einer seitengetrennten Nierenfunktionsuntersuchung mit ^99mTc-MAG₃ überwiesen wurden. Nach ausreichender Hydrierung erfolgte eine Blutentnahme zur Bestimmung von Kreatinin und Cystatin C im Serum sowie die i.v. Injektion des Radiotracers. Entsprechend den Empfehlungen der National Kidney Foundation wurde die glomeruläre Filtrationsrate (GFR) aus dem Serum-Kreatinin nach den Formeln von Cockcroft & Gault und der »Modification of Diet in Renal Disease« (MDRD)-Studie berechnet. Diese GFR-Äquivalente dienten als Referenz. Cystatin C ist ein niedermolekulares Protein, das von allen nukleären Zellen produziert und zu 85% glomerulär filtriert wird. Die Berechnung der ^99mTc-MAG_3-Clearance erfolgte nach Bubeck. Ergebnisse: Die lineare Regressionsanalyse ergab Korrelationskoeffizienten von r = 0,68 und r = -0,69 für den Vergleich von MAG_3-Clearance und Cystatin C mit der nach Cockcroft & Gault bestimmten Kreatinin-Clearance. Für die nach der MDRD Studie bestimmten Clearance betrugen die Korrelationskoeffizienten r = 0,755 und r = -0,77. Diese Unterschiede waren nicht signifikant. Zum Ausschluss einer Nierenfunktionsstörung und zum Nachweis einer zumindest mittelgradigen Nierenfunktionsstörung ergaben sich zwischen Cystatin C und der ^99mTc-MAG₃-Clearance ebenfalls keine signifikanten Unterschiede. Schlussfolgerungen: Cystatin C und ^99mTc-MAG₃-Clearance sind gleichermaßen zum Ausschluss oder zum Nachweis einer relevanten Nierenfunktionsstörung geeignet. Unterschiede ergeben sich vor allem in Abhängigkeit von der jeweiligen Referenzmethode.

Keywords

Creatinine clearance - cystatin C - ^99mTc-MAG₃ clearance

Schlüsselwörter

Kreatinin-Clearance - Cystatin C - ^99mTc-MAG₃ Clearance

Volltext

Referenzen

Literatur
1 American Diabetes Association.. Standards of Medical Care for patients with diabetes mellitus. Diabetes Care 2001; 24 Suppl 33-43.
2 Anonymous.. Excerpts from the 2000 U. S. renal data system annual data report: atlas of end stage renal disease in the United States. Am J Kidney Dis 2000; 36 (Suppl. 01) S1-279.
3 Bubeck B, Brandau W, Weber E. et al. Pharmacokinetics of technetium-99m-MAG3 in humans. J Nucl Med 1990; 31: 1285-93.
4 Bubeck B, Piepenburg R, Grethe U. et al. A new principle to normalize plasma concentrations allowing single-sample clearance determinations in both children and adults. Eur J Nucl Med 1992; 19: 511-6.
5 Bubeck B. Renal clearance determination with one blood sample: improved accuracy and universal applicability by a new calculation principle. Sem Nucl Med 1993; 23: 73-86.
6 Buysschaert M, Joudi I, Wallemacq P. et al. Comparative performance of serum cystatin-C versus serum creatinine in diabetic subjects. Diabetes Metab 2003; 29: 377-83.
7 Christensson A, Ekberg J, Grubb A. et al. Serum cystatin C is a more sensitive and more accurate marker of glomerular filtration rate than enzymatic measurements of creatinine in renal transplantation. Nephron Physiol 2003; 94: 19-27.
8 Cockcroft DW, Gault MH. Prediction of creati-nine clearance from serum creatinine. Nephron 1976; 16: 31-41.
9 Coresh J, Astor BC, Greene T. et al. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis 2003; 41: 1-12.
10 Coresh J, Wei GL, McQuillan G. et al. Prevalence of high blood pressure and elevated serum creatinine level in the United States: findings from the third National Health and Nutrition Examination Survey (1988-1994). Arch Intern Med 2001; 161: 1207-16.
11 Cushman WC. The burden of uncontrolled hypertension: morbidity and mortality associated with disease progression. J Clin Hypertens 2003; 5 (Suppl 2): 14-22.
12 Harmoinen A, Lehtimaki T, Korpela M. et al. Diagnostic accuracies of plasma creatinine, cystatin C, and glomerular filtration rate calculated by the Cockcroft-Gault and Levey (MDRD) formulas. Clin Chem 2003; 49: 1223-5.
13 Henry RM, Kostense PJ, Bos G. et al. Mild renal insufficiency is associated with increased cardiovascular mortality: The Hoorn Study. Kidney Int 2002; 62: 1402-7.
14 Herget-Rosenthal S, Trabold S, Pietruck F. et al. Cystatin C: efficacy as screening test for reduced glomerular filtration rate. Am J Nephrol 2000; 20: 97-102.
15 Hoek FJ, Kemperman FA, Krediet RT. A comparison between cystatin C, plasma creatinine and the Cockcroft and Gault formula for the estimation of glomerular filtration rate. Nephrol Dial Transplant 2003; 18: 2024-31.
16 Laterza OF, Price CP, Scott MG. Cystatin C: an improved estimator of glomerular filtration rate?. Clin Chem 2002; 48: 699-707.
17 Levey AS, Bosch JP, Lewis JB. et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130: 461-70.
18 Levey AS, Coresh J, Balk E. et al. National Kidney Foundation. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 2003; 139: 137-47.
19 Mailloux L, Gagnon JA. Measurement of effective renal plasma flow. Progr Nucl Med 1972; 2: 54-70.
20 McClellan WM, Knight DF, Karp H. et al. Early detection and treatment of renal disease in hospitalized diabetic and hypertensive patients: important differences between practice and published guidelines. Am J Kidney Dis 1997; 29: 368-75.
21 National Kidney Foundation.. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002; 39 (Suppl. 01) S1-266.
22 Newman DJ, Cystatin C. Ann Clin. Biochem 2002; 39: 89-104.
23 Perlemoine C, Beauvieux MC, Rigalleau V. et al. Interest of cystatin C in screening diabetic patients for early impairment of renal function. Metabolism: Clin Experiment 2003; 52: 1258-64.
24 Poge U, Stoschus B, Stoffel-Wagner B. et al. Cystatin C as an endogenous marker of glomerular filtration rate in renal transplant patients. Kidney Blood Press Res 2003; 26: 55-60.
25 Reinhardt MJ, Weidling H, Biersack HJ. et al. Prediction of renal function with Cystatin C, Cockcroft & Gault equation, and ^99mTc-MAG₃ clearance – is there a difference in clinical routine?. Eur J Nucl Med 2003; 30 (Suppl. 02) S368.
26 Remuzzi G, Ruggenenti P, Perico N. Chronic renal diseases: renoprotective benefits of reninangiotensin system inhibition. Ann Intern Med 2002; 136: 604-15.
27 Russell CD, Taylor A, Eshima D. Estimation of technetium-99m-MAG₃ plasma clearance in adults from one or two blood samples. J Nucl Med 1989; 30: 1955-9.
28 Sarnak MJ, Levey AS, Schoolwerth AC. et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation 2003; 108: 2154-69.
29 Smith HW. Comparative physiology of the kidney. In: Smith HW. (ed). The kidney: structure and function in health and disease. New York, Oxford: University Press; 1951: 520-74.
30 Tauxe WN, Maher FT, Taylor WF. Effective renal plasma flow: estimation from theoretical volumes of distribution of intravenously injected 131-I orthoiodo-hippurate. Mayo Clin Proc 1971; 46: 524-31.
31 Taylor A. Radionuclide renography: a personal approach. Sem Nucl Med 1999; 29: 102-27.
32 Wenzel U, Dominiak P, Neumayer HH. et al. Hemmung der Progression von chronischen Nierenerkrankungen. Deutsches Ärzteblatt 2003; 100: 2072-9.
33 Wu PS, Chiu NT, Lee BF. et al. Relationship of formula creatinine clearance, serum creatinine and blood urea nitrogen to 99mTc-MAG3 Clearance. Ann Nucl Med Sci 2002; 15: 77-83.