Nierenfunktionsbestimmungen mit Clearance: Methoden und Indikationen

Zusammenfassung

Um die Nierenfunktion quantitativ zu beurteilen, gibt es viele Methoden. Meistens benutzten die Kliniker die simple Bestimmung des Plasmakreatinins; einige wählen jedoch die Kreatininclearance mit Urinsammlung oder andere alternative, aber indirekte, Methoden. Zur quantitativen Nierenfunktionsmessung ergibt die Isotopenclearance jedoch im Vergleich zu anderen Methoden eine hohe Genauigkeit, ist meist einfach durchzuführen und verursacht eine äußerst geringe Strahlenbelastung. In diesem Überblick werden die unterschiedlichen Radiopharmaka für die Isotopenclearance, deren Vor- und Nachteile, sowie der Clearancebegriff und die unterschiedlichen Clearancetechniken besprochen. Auch eine Zusammenstellung von klinisch wichtigen Indikationen wird genannt. Die Plasmaclearance mit 51-Cr-EDTA nach einmaliger Injektion und mit einer Plasmaprobe ist die meist empfohlene Methode. Bei gewissen speziellen klinischen Situationen empfehlen sich jedoch Modifikationen, die beschrieben werden.

Abstract

Renal function impairment can be monitored by many tests. Measurement of plasma-creatinine level is the most used method, 24 hour plasma-creatininclearance with urine collection is used by others and also other alternative but indirect methods exist. However, the use of radionuclide-clearances is by far the easiest performed method with the highest accuracy and precision and gives very low irradiation dose. In the following we will discuss the different radiopharmaceuticals in use, their plus and minus, the different clearance methods in use, their limitations and give some clinically important indications to perform clearance investigations according to consensus reports. Summarizing the use of plasma clearance of 51-Cr-EDTA after a single injection with one blood sample can be generally recommended, however with some modifications in special clinical situations, which are pointed out.

Schlüsselwörter

Clearance - GFR - Isotopenclearance - 51-Cr-EDTA-„slope”-Clearance - MAG-3-Clearance

Key words

Clearance - GFR - radionuclide clearance - 51-Cr-EDTA single injection clearance - MAG-3 clearance

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