Comparative evaluation of technetium-99m-diethylenetriaminepentaacetic acid renal dynamic imaging versus the Modification of Diet in Renal Disease equation and the Chronic Kidney Disease Epidemiology Collaboration equation for the estimation of GFR

Dependence of Renal Uptake on Kidney Function in [68Ga]Ga-PSMA-11 PET/CT Imaging

(1) Background: PSMA ligand PET/CT is increasingly important for diagnostics of prostate cancer and other tumor diseases. In particular, the radiopharmaceutical [68Ga]Ga-PSMA-11 is widely used. Besides its tumor-specific binding, the uptake within the kidneys is dominant and seems to visualize the renal cortex specifically. Kidney diseases may alter the uptake of radiopharmaceuticals. Therefore, the correlation between renal uptake in PET/CT imaging and renal function should be investigated. (2) Methods: A group of 103 male patients were retrospectively evaluated for eGFR according to the CKD-EPI equation, tracer uptake intensity (SUVmax, SUVpeak, SUVmean), the molecular volume of the renal cortex, morphological kidney size, and total renal uptake. Manual and three different computer-assisted contouring methods (thresholds at 50% of SUVmax, 30% of SUVmax, and absolute SUV of 20) were used for measurements. Correlations between parameters were calculated using linear regression models. (3) Results: Renal SUVmax, SUVpeak, and SUVmean do not correlate with eGFR for manual or computer-assisted measurements. In contrast, molecular cortex volume shows a moderate correlation with eGFR (R2 = 0.231, p < 0.001), superior to morphological kidney size. A contouring threshold of 30% of SUVmax outperformed the other settings for renal cortex volume and total renal uptake. (4) Conclusions: Renal uptake of [68Ga]Ga-PSMA-11 cannot predict eGFR, but the functional renal cortex can be quantified by PET/CT imaging.

Decline in measured glomerular filtration rate is associated with simple renal cyst in Chinese patients with type 2 diabetes

AIMS/INTRODUCTION

Simple renal cysts (SRC) are associated with age, hypertension and hyperuricemia, which are risk factors of renal impairment. This study aimed to investigate the prevalence of SRC and its association with measured glomerular filtration rate (mGFR) in patients with type 2 diabetes mellitus in China.

METHODS

A total of 3,552 patients with type 2 diabetes mellitus admitted to Shanghai Sixth People's Hospital from January 2012 to December 2016 were investigated. All participants were diagnosed as SRC by color Doppler, and all participants were measured for GFR by using dynamic renal scintigraphy with technetium-99m-diethylene triamine peta-acetic acid.

RESULTS

The prevalence of SRC was 17.4% (619 cases). Participants with SRC had significantly lower mGFR values than those without SRC (86.16 ± 26.20 vs 94.88 ± 23.98 mL/min/1.73 m2 , P < 0.001). In 478 participants with unilateral renal cyst, the mGFR of the kidney affected by SRC was significantly lower than that of the unaffected kidney (43.32 ± 13.74 vs 44.18 ± 13.34 mL/min/1.73 m2 , P = 0.014). The participants were divided into four groups according to the quartiles of mGFR level (≥109.50, 93.80-109.49, 76.90-93.79 and <76.90 mL/min/1.73 m2 ). The prevalence of SRC gradually increased with decreasing mGFR level (12.9, 13.9, 16.6 and 27.8%, respectively; P trend <0.01). After adjusting for age, sex, duration of diabetes, hypertension and other potential confounders, the logistic regression showed that SRC was an independent risk factor for impaired GFR (<60 mL/min/1.73 m2 ; odds ratio 1.656; 95% confidence interval 1.451-1.890, P < 0.001).

CONCLUSION

SRC is an independent risk factor for the decrease of mGFR in Chinese diabetes patients, and could affect the renal GFR measured by dynamic renal scintigraphy on the SRC side.

Association of Renal Function (Estimate Glomerular Filtration Rate) with the Number of Febrile Urinary Tract Infections in Children with Neurogenic Bladder

INTRODUCTION

 Our objective was to evaluate whether renal function, assessed as the estimated glomerular filtration rate (eGFR), is associated with the number of febrile urinary tract infections (FUTIs) in children diagnosed with neurogenic bladder (NB).

MATERIALS AND METHODS

 Clinical information of patients diagnosed with NB was prospectively collected between January 2013 and January 2022. Episodes of FUTI were recorded during the follow-up period, and the eGFR was calculated based on the serum cystatin C level. Grading (G1-G5) of chronic kidney disease (CKD) was conducted as described by the eGFR.

RESULTS

 In total, 463 children were included in the final analysis (265 males and 198 females; mean age: 23 months). The median follow-up time was 51 months. A total of 302 children had four or more FUTIs and 161 children had none to three FUTIs. The incidence of developing CKD G3 to G5 gradually increased from the first to third (1.3-2.4%) episodes of FUTI and drastically increased after four episodes (≥ 22.5%), with the incidence recorded to be 100% after eight FUTIs. The odds of CKD G3 to G5 in children with four FUTIs were 17.3 and 43.7 times greater after four and six FUTIs, respectively, than in children with one FUTI.

CONCLUSION

 This study showed that recurrent FUTIs are common in children with NB and that the risk of rapid progression to CKD G3 to G5 increases substantially after four or more FUTIs episodes.

Predicting estimated glomerular filtration rate after partial and radical nephrectomy based on split renal function measured by radionuclide: a large-scale retrospective study

PURPOSE

The purpose of this study was to develop predictive models for postoperative estimated glomerular filtration rate (eGFR) based on the split glomerular filtration rate measured by radionuclide (rGFR), as choosing radical nephrectomy (RN) or partial nephrectomy (PN) for complex renal masses requires accurate prediction of postoperative eGFR.

METHODS

Patients who underwent RN or PN for a single renal mass at Xijing Hospital between 2008 and 2022 were retrospectively included. Preoperative split rGFR was evaluated using technetium-99 m-diethylenetriaminepentaacetic acid (Tc-99 m DTPA) renal dynamic imaging, and the postoperative short-term (< 7 days) and long-term (3 months to 5 years) eGFRs were assessed. Linear mixed-effect models were used to predict eGFRs, with marginal R2 reflecting predictive ability.

RESULTS

After excluding patients with missing follow-up eGFRs, the data of 2251 (RN: 1286, PN: 965) and 2447 (RN: 1417, PN: 1030) patients were respectively included in the long-term and short-term models. Two models were established to predict long-term eGFRs after RN (marginal R2 = 0.554) and PN (marginal R2 = 0.630), respectively. Two other models were established to predict short-term eGFRs after RN (marginal R2 = 0.692) and PN (marginal R2 = 0.656), respectively. In terms of long-term eGFRs, laparoscopic and robotic surgery were superior to open surgery in both PN and RN.

CONCLUSIONS

We developed novel tools for predicting short-term and long-term eGFRs after RN and PN based on split rGFR that can help in preoperative decision-making.

Measurement and estimation of glomerular filtration rate in children with neurogenic bladder: A prospective study

OBJECTIVE

To evaluate the performance of different equations used to estimate glomerular filtration rate (GFR) in children with neurogenic bladder (NB).

METHODS

The GFR measured with the technetium-99m-diethylenetriaminepentaacetic acid (^99mTc-DTPA) dual-plasma sample clearance method was defined as the true GFR (tGFR). The Chronic Kidney Disease in Children (CKiD) equation for serum creatinine (Scr) and/or cystatin C (Cys C) was used for GFR calculation. Estimated GFR (eGFR) using CKiD_Scr, CKiD_{Cys C}, and CKiD_{Scr+Cys C} equations was compared with tGFR in children with NB RESULTS: In total, 458 children with NB were prospectively enrolled in this study. The mean tGFR was 73.84±18.54 ml/min/1.73 m², mean eGFR_Scr was 77.94±18.38 ml/min/1.73 m², mean eGFR_{Cys C} was 74.20± 17.64 ml/min/1.73 m², and mean eGFR_{Scr+Cys C} was 75.70±18.07 ml/min/1.73 m². The correlation between the Scr-based equation and ^99mTc-DTPA clearance method was low (r=0.648). The Cys C-based equations exhibited the strongest correlations: CKiD_{Cys C} (r=0.891) and CKiD_{Scr+Cys C} (r=0.879). The overall prevalence of chronic kidney disease (CKD) was 20.7%, 19.7%, 17.5%, and 12.4% according to tGFR, eGFR_{Cys C}, eGFR_{Cys C+Scr} and eGFR_Scr, respectively. The area under the curve (AUC) for the Receiver operating characteristic (ROC) curve of the CKiD_{Cys C} equation was the highest (AUC_CKiDcys= 0.956).

CONCLUSIONS

The Cys C-based CKiD equation was the most accurate for estimating GFR compared with ^99mTc-DTPA clearance method in children with NB. The CKiD_Scr equation overestimated the GFR. The CKiD_{Cys C} equation can be used to detect initial stages of CKD in children with NB.

Effect of Levosimendan on Acute Decompensated Right Heart Failure in Patients With Connective Tissue Disease-Associated Pulmonary Arterial Hypertension

Aims

Acute decompensated right heart failure (RHF) in chronic precapillary pulmonary hypertension is often typified by a swiftly progressive syndrome involving systemic congestion. This results from the impairment of the right ventricular filling and/or a reduction in the flow output of the right ventricle, which has been linked to a dismal prognosis of short duration. Despite this, there are limited therapeutic data regarding these acute incidents. This study examined the effect of levosimendan on acute decompensated RHF in patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH).

Methods

This retrospective study included 87 patients with confirmed CTD-PAH complicated acute decompensated RHF between November 2015 and April 2021. We collected biological, clinical, and demographic data, as well as therapy data, from patients with acute decompensated RHF who required levosimendan treatment in the cardiac care unit (CCU) for CTD-PAH. The patients were divided into two groups according to the levosimendan treatment. Patient information between the two groups was systematically compared in hospital and at follow-up.

Results

Oxygen saturation of mixed venose blood (SvO₂), estimated glomerular filtration rate (eGFR), 24-h urine output, and tricuspid annular plane systolic excursion (TAPSE) were found to be considerably elevated in the levosimendan cohort compared with the control cohort. Patients in the levosimendan cohort exhibited considerably reduced levels of C-reactive protein (CRP), white blood cell (WBC), troponin I, creatinine, NT-proBNP, and RV diameter compared with those in the control cohort. A higher survival rate was observed in the levosimendan cohort.

Conclusions

Levosimendan treatment could effectively improve acute decompensated RHF and systemic hemodynamics in CTD-PAH patients, with positive effects on survival in hospital and can, therefore, be considered as an alternative treatment option for improving clinical short-term outcomes.

The ideal marker for measuring GFR: what are we looking for?

Introduction:

The most accurate way of assessing kidney function is the measurement of the glomerular filtration rate (GFR). Since, we do not have good formulae to estimate GFR in elderly, in this study we evaluate the accuracy of the most commonly used formulas for the estimation of GFR in comparison with direct measurement in elderly.

Materials and Methods:

85 patients (51 males and 34 females), with an average age of 76.2 ± 4.4 years, 42% already diagnosed with chronic kidney disease (CKD) were investigated. Two plasma samples were collected between 60-90 and 165-195 minutes after injection of ^99mTc-DTPA, and the GFR was calculated applying Charles D. Russell’s two-sample method.

Results:

When comparing the GFR values obtained from the various formulae by creatinine levels with the GFR values obtained by measuring ^99mTc-DTPA residue, the following concordance values emerged: (1) MDRD: 57.5 ± 9.59 %; (2) Cockroft-Gault: 48.33 ± 24.93; (3) CKD-EPI: 49.40 ± 26.30; (4) BIS1: 58 ± 6.79.

Conclusion:

Our data shows a greater concordance between the GFR values calculated with the Russell’s method and the estimated values of GFR when the latter are calculated using the MDRD or BIS1 formulae. (www.actabiomedica.it)

Validation of the full-age spectrum equation in the approximation of glomerular filtration rate in Chinese patients with chronic kidney disease

Introduction: To investigate the validity of the full age spectrum (FAS) equation in determining the glomerular filtration rate (GFR) in Chinese patients with chronic kidney disease (CKD) and to compare the performance of FAS equation and the technetium-99m-diethylene triamine pentaacetic acid (Tc-99m-DTPA) renal dynamic imaging method. Methods: The GFR was determined by three methods in the same day: (a) Tc-99m-DTPA dual plasma sample clearance method (mGFR); (b) FAS equation (eGFR1); (c) Tc-99m-DTPA renal dynamic imaging method (eGFR2). The mGFR was used as the reference standard. The Bland-Altman method, concordance correlation coefficient and regression equation were applied to evaluate the validity of the estimated glomerular filtration rate (eGFR). The bias, precision and accuracy were analyzed to compare the performances of eGFR1 and eGFR2. Results: A total of 162 subjects were enrolled in this study. The eGFR1 was correlated well with mGFR (concordance correlation coefficient was 0.896, p < 0.0001) and the regression equation was mGFR = -0.374 + 1.029eGFR1 (p < 0001). The Bland-Altman analysis proved good agreement between the eGFR1 and mGFR. In comparison with eGFR2, the eGFR1 showed better performance on bias (-1.22 vs. 8.92, p < 0001), precision (15.69 vs. 18.36, p  =  0.047) and 30% accuracy (75.31% vs. 59.26%, p  =  0.0009) in all participants. Conclusions: The FAS equation is valid in determining the glomerular filtration rate in Chinese patients with chronic kidney disease. The Tc-99m-DTPA renal dynamic imaging method is less accurate than the FAS equation and cannot be employed as the reference method in assessing the performance of FAS equation.