Iohexol plasma clearance for measuring glomerular filtration rate in clinical practice and research: a review. Part 1: How to measure glomerular filtration rate with iohexol?
| Autor: | Pierre Delanaye, Natalie Ebert, Toralf Melsom, Flavio Gaspari, Christophe Mariat, Etienne Cavalier, Jonas Björk, Anders Christensson, Ulf Nyman, Esteban Porrini, Giuseppe Remuzzi, Piero Ruggenenti, Elke Schaeffner, Inga Soveri, Gunnar Sterner, Bjørn Odvar Eriksen, Sten-Erik Bäck |
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| Rok vydání: | 2016 |
| Předmět: |
glomerular filtration rate
Transplantation VDP::Medical disciplines: 700::Clinical medical disciplines: 750 urogenital system VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750 030232 urology & nephrology Measuring Gfr 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Nephrology Urologi och njurmedicin Urology and Nephrology iohexol |
| Zdroj: | Clinical Kidney Journal |
| ISSN: | 2048-8513 2048-8505 |
| DOI: | 10.1093/ckj/sfw070 |
| Popis: | Published version. Source at http://dx.doi.org/10.1093/ckj/sfw070 While there is general agreement on the necessity tomeasure glomerular filtration rate (GFR) inmany clinical situations, there is less agreement on the bestmethod to achieve this purpose.As the gold standardmethod for GFR determination, urinary (or renal) clearance of inulin, fades into the background due to inconvenience and high cost, a diversity of filtrationmarkers and protocols compete to replace it. In this review, we suggest that iohexol, a non-ionic contrast agent, is most suited to replace inulin as the marker of choice for GFR determination. Iohexol comes very close to fulfilling all requirements for an ideal GFRmarker in terms of low extra-renal excretion, low protein binding and in being neither secreted nor reabsorbed by the kidney. In addition, iohexol is virtually non-toxic and carries a low cost. As iohexol is stable in plasma, administration and sample analysis can be separated in both space and time, allowing access to GFR determination across different settings. An external proficiency programme operated by Equalis AB, Sweden, exists for iohexol, facilitating interlaboratory comparison of results. Plasma clearance measurement is the protocol of choice as it combines a reliable GFR determination with convenience for the patient. Single-sample protocols dominate, butmultiple-sample protocolsmay bemore accurate in specific situations. In lowGFRs one ormore late samples should be included to improve accuracy. In patients with large oedema or ascites, urinary clearance protocols should be employed. In conclusion, plasma clearance of iohexol may well be the best candidate for a common GFR determination method. |
| Databáze: | OpenAIRE |
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