Is DtPa the Gold Standard for Glomerular Filtration Rate Estimation in Voluntary Kidney Donors before and after Donor Nephrectomy?

Introduction: Precise assessment of renal function of voluntary kidney donors has important implications for both donor and recipient health outcome. The ideal test for assessment of overall renal function is measurement of Glomerular Filtration Rate (GFR). Various centres use various creatinine based formulae to calculate the GFR, however when compared to GFR measurements by 99mTc-diethylenetriaminepentaacetic acid (DTPA) isotope clearance, their performance remain inconclusive. Aim: To assess the efficacy of creatinine-based GFR estimating equations in comparison to DTPA scan in voluntary kidney donors before and after donor nephrectomy. Materials and Methods: This study was conducted on 50 voluntary kidney donors who underwent donor nephrectomy at Army Hospital (R&R), New delhi. This study was conducted from November 2016 to March 2018 as a single centre, prospective, longitudinal cohort study on living related kidney donors with follow up at 1 and 3 months after kidney donation. The predictive capabilities of GFR estimation by Cockroft Gault (CG) equation, CG equation corrected for GFR and 24-hour urine Creatinine Clearance (CrCl) corrected for Body Surface Area (BSA), for both pre- and postdonor nephrectomy at 90 days, were assessed and further compared with DTPA-GFR as reference GFR. Individual quantitative parameters were compared using Student t test. For the normally distributed GFR data, Pearson’s correlation coefficient was also calculated. Statistical Package for the Social Sciences (SPSS), version 24.0, software and MS Excel were used for analysis. Results: Out of 50 subjects studied, 38 (76%) were females and 12 (24%) were males. Majority of donors were spouses. The mean GFR measured by 99mTc-DTPA scan was 99.47±14.4 ml/min/1.73m2 and 62.1±11.5 ml/min/1.73 m2 pre and postdonation respectively. All the equations being evaluated in this study underestimated the GFR as measured by 99mTc DTPA renal scan prior to kidney donation whereas GFR estimation postdonor nephrectomy by CG CrCl and CG GFR overestimated the GFR values while Urine CrCl underestimated it. Conclusion: All the equations performed unsatisfactorily. Even the best performing equation urine-CrCl was also found to be suboptimal for donor evaluation. More accurate methods of GFR estimation, should, thus be used keeping the potential risks of living kidney donation in perspective.

Download Full-text

Comparison of Estimating Equations for the Prediction of Glomerular Filtration Rate in Kidney Donors before and after Kidney Donation

PLoS ONE ◽

10.1371/journal.pone.0060720 ◽

2013 ◽

Vol 8 (4) ◽

pp. e60720 ◽

Cited By ~ 12

Author(s):

Byung Ha Chung ◽

Jee Hyun Yu ◽

Hyuk Jin Cho ◽

Ji-Il Kim ◽

In Sung Moon ◽

...

Keyword(s):

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Filtration Rate ◽

Estimating Equations ◽

Kidney Donation ◽

Kidney Donors ◽

Before And After

Download Full-text

Organ-Specific Monitoring of Solitary Kidney after Living Donation by Using Markers of Glomerular Filtration Rate and Urinary Proteins

Urologia Internationalis ◽

10.1159/000515674 ◽

2021 ◽

pp. 1-7

Author(s):

Gerit Theil ◽

Karl Weigand ◽

Kersten Fischer ◽

Joanna Bialek ◽

Paolo Fornara

Keyword(s):

Molecular Weight ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Filtration Rate ◽

Donor Nephrectomy ◽

Kidney Donation ◽

Low Molecular Weight ◽

Tubular Damage ◽

Urinary Proteins

Background: Effective follow-up after living kidney donation is important for maintaining the renal function of the donor. We investigated whether the estimated glomerular filtration rate (eGFR) and urinary protein and enzyme levels can provide important information regarding the state of the remaining kidney after donor nephrectomy. Methods: Seventy-five living donations were included (prospective/retrospective) in the study. The following parameters were measured up to 1 year after donor nephrectomy: serum creatinine and cystatin C as markers of the GFR; the high-molecular-weight urinary proteins as markers of glomerular injury; and the low-molecular-weight urinary proteins and urinary enzymes as markers of tubular function. Results: One year after kidney donation, the creatinine and cystatin C values were 1.38-fold increased than their initial values, while the eGFR was 32% lower. At that time, 38% of donors had a moderate or high risk of CKD progression. The biochemical urinary glomerular and tubular kidney markers examined showed different behaviors. After a transient increase, the glomerular proteins normalized. Conversely, the detection of low-molecular-weight urinary proteins and enzymes reflected mild tubular damage at the end of the study period. Conclusions: Our findings suggest that for the evaluation of mild tubular damage, low-molecular-weight marker proteins should be included in the urine diagnostic of a personalized living kidney donor follow-up.

Download Full-text

Assessing glomerular filtration rate in healthy adult potential kidney donors in Bangladesh: A comparison of various prediction equations with measured glomerular filtration rate by diethylentriamine pentaacetic acid renogram

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v39i2.19646 ◽

2014 ◽

Vol 39 (2) ◽

pp. 74-79

Author(s):

F Jahan ◽

MNU Chowdhury ◽

T Mahbub ◽

SM Arafat ◽

S Jahan ◽

...

Keyword(s):

Renal Function ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Filtration Rate ◽

Healthy Adult ◽

Healthy Population ◽

Prediction Equations ◽

Estimated Gfr ◽

Kidney Donors ◽

Measured Gfr

To ensure that potential kidney donors in Bangladesh have no renal impairment, it is extremely important to have accurate methods for evaluating the glomerular filtration rate (GFR). We evaluated the performance of serum creatinine based GFR in healthy adult potential kidney donors in Bangladesh to compare GFR determined by DTPA with that determined by various prediction equations. In this study GFR in 61 healthy adult potential kidney donors were measured with 99mTc-diethylenetriamine penta-acetic acid (DTPA) renogram. We also estimated GFR using a four variable equation modification of diet in renal disease (MDRD), Cockcroft-Gault creatinine clearance (CG CrCl), Cockcroft-Gault glomerular filtration rate (CG-GFR). The mean age of study population was 34.31±9.46 years and out of them 65.6% was male. In this study mean mGFR was 85.4±14.8. Correlation of estimated GFR calculated by CG-CrCl, CG-GFR and MDRD were done with measured GFR DTPA using quartile. Kappa values were also estimated which was found to be 0.104 for (p=0.151), 0.336 for (p=0.001) and 0.125 for (p=0.091) respectively. This indicates there is no association between estimated GFR calculated by CG-CrCl, CG-GFR, MDRD with measured GFR DTPA. These results show poor performance of these equations in evaluation of renal function among healthy population and also raise question regarding validity of these equations for assessment of renal function in chronic kidney disease in our population. DOI: http://dx.doi.org/10.3329/bmrcb.v39i2.19646 Bangladesh Med Res Counc Bull 2013; 39: 74-79

Download Full-text

FP307IMPROVEMENT OF RENAL FUNCTION EVALUATION IN LIVING KIDNEY DONORS: ROLE OF RADIOISOTOPIC GLOMERULAR FILTRATION RATE AND OF RENAL FUNCTIONAL RESERVE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfz106.fp307 ◽

2019 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Gabriele Guglielmetti ◽

Angelo Nappo ◽

Umberto Maria Morosini ◽

Gian Mauro Sacchetti ◽

Ronco Claudio ◽

...

Keyword(s):

Renal Function ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Filtration Rate ◽

Function Evaluation ◽

Functional Reserve ◽

Kidney Donors ◽

Living Kidney Donors ◽

Renal Functional Reserve

Download Full-text

Assessing glomerular filtration rate in patients with severe heart failure: comparison between creatinine-based formulas

Sao Paulo Medical Journal ◽

10.1590/s1516-31802012000500004 ◽

2012 ◽

Vol 130 (5) ◽

pp. 289-293 ◽

Cited By ~ 1

Author(s):

Alexandre Libório ◽

Russian Uchoa ◽

João Neto ◽

Juan Valdivia ◽

Elizabeth De Francesco Daher ◽

...

Keyword(s):

Heart Failure ◽

Renal Function ◽

Glomerular Filtration Rate ◽

Serum Creatinine ◽

Glomerular Filtration ◽

Filtration Rate ◽

Severe Heart Failure ◽

Creatinine Concentration ◽

Cross Sectional ◽

Gfr Estimation

CONTEXT AND OBJECTIVE: Severe heart failure is highly associated with chronic kidney disease (CKD). Serum creatinine is a poor indicator of renal function and glomerular filtration rate (GFR) estimation is an accessible method for assessing renal function. The most popular formulas for GFR estimation are the Cockcroft-Gault (CG), the four-variable Simplified Modification of Diet in Renal Disease (sMDRD) and the recently introduced CKD-Epidemiology Collaboration (CKD-EPI). The objective of the study was to analyze the correlation between these three equations for estimating GFR in patients with severe heart failure. DESIGN AND SETTING: Cross-sectional observational study at a university reference center. METHODS: GFR was estimated in patients with severe heart failure who were awaiting heart transplantation, using the CG, sMDRD and CKD-EPI formulas. These estimates were analyzed using Pearson's correlation and Bland-Altman analysis. RESULTS: This study included 157 patients, of whom 32 (20.3%) were female. Normal serum creatinine concentration was observed in 21.6%. The mean GFR according to CG, sMDRD and CKD-EPI was 70.1 ± 29.5, 70.7 ± 37.5 and 73.7 ± 30.1 ml/min/1.73 m²; P > 0.05. Pearson's coefficient demonstrated good correlations between all the formulas, as did Bland-Altman. However, the patients presented GFR < 60 ml/min more frequently with the sMDRD formula (54.1% versus 40.2% for CG and 43.2% for CKD-EPI; P = 0.02). CONCLUSION: Despite the good correlation and agreement between the three methods, the sMDRD formula classified more patients as presenting GFR less than 60 ml/min.

Download Full-text

611 Change in renal function after donor nephrectomy: An assessment using TC 99m-DTPA glomerular filtration rate

European Urology Supplements ◽

10.1016/s1569-9056(13)61094-5 ◽

2013 ◽

Vol 12 (1) ◽

pp. e611

Author(s):

H.J. Cho ◽

Y.S. Choi ◽

W.J. Bae ◽

J.H. Bae ◽

S.J. Kim ◽

...

Keyword(s):

Renal Function ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Filtration Rate ◽

Donor Nephrectomy

Download Full-text

A Comparison of Glomerular Filtration Rate by Creatinine Based Equations and DTPA-Renogram in Healthy Adult Kidney Donors

Journal of Nepal Medical Association ◽

10.31729/jnma.2111 ◽

2013 ◽

Vol 52 (190) ◽

Author(s):

Ramesh Kumar Chaurasia ◽

Rajendra Kumar Agrawal ◽

Rajani Hada ◽

Sweta Kumari Chaurasia ◽

Santosh Gurung ◽

...

Keyword(s):

Glomerular Filtration Rate ◽

Creatinine Clearance ◽

Glomerular Filtration ◽

Kidney Function ◽

Filtration Rate ◽

Pearson Correlation ◽

Accurate Determination ◽

Kidney Donors ◽

Gfr Estimation ◽

Measured Gfr

Introduction: Accurate determination of donor kidney function has important long-term implications for both donor health and recipient outcome. Many centers use 24 hour urinary creatinine clearance or creatinine-based GFR estimations to assess kidney function but their performance when compared with GFR measurements by isotope clearance remains inconclusive. We assessed the performance of creatinine based equations against DTPA GFR for evaluating Nepalese kidney donors.Methods: All kidney donors who had undergone both DTPA GFR estimation and 24 hour urine CrCl were included. The performance of the urine-CrCl, CG-CrCl, modified MDRD GFR against DTPA GFR was evaluated by analyzing global bias, precision (R2),Pearson correlation and accuracy percentage within 30% and 15%. The sensitivity and specificity of each predictive equation in selecting donor with GFR of ≥80 mL/min/1.73 m2 was also calculated.Results: Of 51 donors analysed, only 18 (35.29%) were male. The mean measured GFR was 102.752±16.71 mL/min/1.73 m2. Of all prediction equations, urine-CrCL has most precision (R2=0.207) with the highest pearson correlation (0.455) and highest accuracy percentage within 30% and 15%. However, predictive performance was poor for all the equations. The urine CrCl had highest sensitivity of 100% for detecting donor with measured GFR>80 mL/min/1.73 m2 with positive predictive value of 92.1%.Conclusions: The performance of all equations was disappointing and even the best performing equation urine-CrCl was suboptimal for donor selection. So considering the potential risk of living kidney donation, other more accurate methods of GFR estimation should be used._________________________________________________________Keywords: Cockcroft-Gault equation; creatinine clearance; glomerular filtration rate; modification of diet in enal disease formula; 99mTc-Diethylene-Triamine Pentaacetic Acid.

Download Full-text