Is DTPA the Gold Standard for Glomerular
Filtration Rate Estimation in Voluntary Kidney
Donors before and after Donor Nephrectomy?
Published: June 1, 2021 | DOI: https://doi.org/10.7860/JCDR/2021/48903.14969
Prashant Bahirani, Raghav Talwar, Amit Kumar Singh, Ajay Shankar Prasad, Gagandeep Singh, Nimit Solanki, Prashant Kumar Dixit
1. Assistant Professor, Department of Surgery, Army College of Medical Sciences, New Delhi, India.
2. Professor, Department of Urology, Command Hospital Airforce, Bangalore, Karnataka, India.
3. Doctor, Department of Surgery, Armed Forces Medical Services, New Delhi, India.
4. Commanding Officer, Department of Medicine, 11 Airforce Hospital, Ghaziabad, Uttar Pradesh, India.
5. Doctor, Department of Urology, Command Hospital Northern Command, Udhampur, Jammu and Kashmir, India.
6. Doctor, Department of Urology, Base Hospital Delhi Cantt, New Delhi, India.
7. Assistant Professor, Department of Medicine, Command Hospital Airforce, Bangalore, Karnataka, India.
Correspondence
Dr. Prashant Bahirani,
OMQ 141, Officer’s Enclave, Airforce Station, Hindan,
Ghaziabad-201004, Uttar Pradesh, India.
E-mail: prashant.bahirani@gmail.com
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 different 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, India. It 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, 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/ 1.73 m2 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.
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