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¹Nuclear Medicine Department, Providence St. Vincent Medical Center, Portland, OR 97225, USA. garry_gates@providence.org

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Summary

Filtration fraction (GFR/ERPF) decreases with advancing renal disease, except in ATN or contrast nephropathy. This finding supports using DTPA and MAG3 in renography for GFR estimation and improved imaging.

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Area of Science:

Nephrology
Nuclear Medicine
Radiology

Background:

Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) are key indicators of kidney function.
Filtration fraction (FF), calculated as GFR/ERPF, provides insights into renal hemodynamics and disease progression.
Traditional renography protocols have evolved with the availability of new radiopharmaceuticals.

Purpose of the Study:

To determine GFR and ERPF in 92 patients to calculate FF and assess its changes in various renal diseases.
To establish a renogram protocol using DTPA for GFR estimation and MAG3 for imaging and curve analysis.

Main Methods:

Individual kidney GFR and ERPF were measured using gamma camera techniques with Tc-99m DTPA and I-131 OIH.
Data were collected from 261 determinations in 92 patients categorized into normal, obstruction, renal vascular disease, and chronic insufficiency groups.

Main Results:

Mean FF was similar in normal (0.16) and obstruction (0.15) groups, but lower in renal vascular disease (0.11) and chronic insufficiency (0.08).
A low FF generally indicates a disproportionate loss of GFR relative to ERPF, characteristic of progressive renal disease.
An elevated FF (0.22) was observed in acute tubular necrosis (ATN) or contrast nephropathy, due to a disproportionate loss of ERPF.

Conclusions:

I-131 OIH is no longer available; Tc-99m MAG3 is the current renal tubular agent.
While MAG3 clearance doesn't directly measure ERPF, GFR measurement during renography remains clinically relevant as GFR is more affected by renal disease than ERPF (except in ATN/contrast nephropathy).
A combined DTPA and MAG3 renogram protocol allows for GFR estimation and provides superior renal images and curves, adapting to current clinical practice.