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Simplified methods for assessment of renal function as the ratio of glomerular filtration rate to extracellular fluid volume

Jødal, Lars; Brøchner-Mortensen, Jens

doi: 10.1097/MNM.0b013e3283591908
Original Articles

Background: Instead of scaling glomerular filtration rate (GFR) to a body surface area of 1.73 m2, it has been suggested to scale GFR to extracellular fluid volume (ECV). The ratio GFR/ECV has physiological meaning in that it indicates how often ‘that which is to be regulated’ (i.e. ECV) comes into contact with the ‘regulator’ (i.e. the kidneys).

Aim: The aim of the present study was as follows: to analyse two published calculation methods for determining ECV and GFR/ECV; to develop a new simple and accurate formula for determining ECV; and to compare and evaluate these methods.

Materials and methods: GFR was determined as 51Cr-EDTA clearance. The study comprised 128 individuals (35 women, 66 men and 27 children) with a full 51Cr-EDTA plasma concentration curve, determined from injection until 4–5 h p.i. Reference values for GFR and ECV were calculated from the full curve. One-pool approximations Cl 1 and V 1 were calculated using only the final-slope curve. Four calculation methods were compared: simple one-pool values; GFR/ECV according to Peters and colleagues; ECV according to Brøchner-Mortensen (BM); and ECV according to a new method (JBM): y=2x−1, where x=Cl 1/Cl and y=V 1/ECV.

Results: The new JBM method is accurate and can be explained theoretically. BM has a slight bias for high renal function. The Peters method had bias in our data. GFR/ECV had better precision than ECV alone, especially for BM and JBM, which were within −4% to +7% of the reference values (95% limits of agreement in adults).

Conclusion: GFR/ECV can be precisely determined, especially with the BM and JBM methods. Expressing GFR/ECV in unit %/h gives a simple interpretation. Normal ranges for GFR/ECV need to be established.

Department of Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark

Correspondence to Lars Jødal, MSc, Department of Nuclear Medicine, Aalborg University Hospital, P.O. Box 365, DK-9100 Aalborg, Denmark Tel: +45 9932 3139; fax: +45 9932 3145; e-mail:

Received February 14, 2012

Accepted August 2, 2012

© 2012 Lippincott Williams & Wilkins, Inc.