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Evaluation of renal function in low-dose cyclosporine-treated patients using technetium-99m diaminocyclohexane: a cationic tubular excretion agent
Authors:Kerim Sonmezoglu  T. Yusuf Erdil  Mustafa Demir  Haluk B. Sayman  Levent Kabasakal  O. Fehmi Yardi  Hamdi Özkara  M. Cem Mat  Kishor Solanki  Keith E. Britton
Affiliation:(1) Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University, Turkey, TR;(2) Department of Urology, Cerrahpasa Medical Faculty, Istanbul University, Turkey, TR;(3) Department of Dermatology, Cerrahpasa Medical Faculty, Istanbul University, Turkey, TR;(4) Department of Nuclear Medicine, St. Bartholomew’s Hospital, London, UK, GB
Abstract:Technetium-99m diaminocyclohexane (DACH) is a new tubular agent excreted via a cationic transport mechanism, like cyclosporine-A (CsA). It is expected that 99mTc-DACH will permit effective assessment of tubular function in CsA-treated patients. To establish the pharmacokinetic characteristics of 99mTc-DACH and to ascertain whether this new agent is useful in CsA-treated patients, 11 healthy volunteers and 15 CsA-treated patients underwent renal imaging and clearance studies using 99mTc-DACH and chromium-51 ethylene diamine tetra-acetic acid (EDTA). 99mTc-DACH yielded satisfactory dynamic renal images in all participants. The mean plasma clearance of 99mTc-DACH was significantly greater than that of 51Cr-EDTA in volunteers (109.4±19.7 ml/min versus 86.6±13.7 ml/min, P<0.05). However, the urinary excretion of 99mTc-DACH at 90 min was significantly lower than that of 51Cr-EDTA (46.1%±9.3% versus 53.1%±8.6%, P<0.05), most probably due to its partial parenchymal retention. The elimination half-life of 99mTc-DACH was significantly increased in CsA-treated patients in comparison to volunteers, and consequently the plasma clearance values were significantly suppressed in these patients, in contrast to 51Cr-EDTA and endogenous creatinine clearance values. In conclusion, our findings indicate that 99mTc-DACH, as a sensitive marker of cationic tubular function, could be used to monitor renal haemodynamics in patients receiving CsA treatment. Received 19 June and in revised form 28 July 1998
Keywords:: Technetium-99m diaminocyclohexane  Cyclosporine nephrotoxicity  Chromium-51 ethylene diamine tetra-acetic acid  Glomerular filtration rate  Plasma clearance rate
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