GFR Measurement using Plasma Sampling: Guidelines and Analysis Tools
The page includes the following:
· Key published references
· A Powerpoint presentation on the 'practicalities of GFR measurement', given at the autumn BNMS meeting in September 2003.
· Information on the new BNMS guidelines (formally adopted April 2004)
· Information on an Excel spreadsheet, which is compliant with BNMS guidelines.
Key published references
Existing relevant guidelines:
1. Blaufox MD, et al. Report of the Radionuclides in Nephrourology Committee on renal clearance. J Nucl Med 1997; 37:1883-1890
2. Piepsz A, et al. Guidelines for glomerular filtration rate determination in children. Eur J Nucl Med 2001; 13: BP31-36.
(The above paediatric guidelines are also available in the guidelines section of the EANM web site)
Basic principles of GFR measurement using radionuclides (Module II: Practice)
This presentation was given by Philip Cosgriff at the Autumn BNMS meeting in September 2003. It followed on from an introductory presentation by John Fleming on the background theory of GFR measurement using radionuclides. The file is made available here as a PDF (converted from Powerpoint) allowing viewing and printing only. You will therefore need the free Adobe Acrobat viewer in order to read the file (see Home page). It is a largish file (5.4 MB) so suggest that you download it to your local machine (right-click, then select Save Target As.) rather than view on-line (left-click) as it could be slow to load, depending on your connection speed. The presentation contains a few extra slides not shown in Bath due to time constraints. Right-click here to download the PDF file.
Although this presentation was given a long time ago, the basic principles haven’t changed.
Given that we already have guidelines, why do we need any more? Well, the UK national audit of GFR measurement, conducted in 2001 (see www.bnms.org.uk for details (Quality Assurance | IPEM Software Group section), showed that the awareness of these guidelines was low and, more importantly, that they were not prescriptive enough to have prevented the variability observed in the audit. The BNMS procedure guideline is thus more detailed and prescriptive than the two guidelines cited above, but will obviously refer to them (particularly the EANM paediatric guidelines) where appropriate.
For more information on IPEM software audit program, go to www.nmsqg.org
A repeat UK GFR audit was performed in late 2013 and results will be presented at the BNMS Spring meeting in May 2014. See www.bnms.org.uk
More information on the justification for the guidelines is contained in an editorial published in August 2004:
Fleming JS, Nunan TO. The new BNMS guidelines for the measurement of glomerular filtration rate. Nucl Med Commun 2004: 25: 755-757.
The guidelines were formally adopted as official BNMS guideline at the annual scientific meeting of the Society in April 2004 and are therefore now in the public domain area of the web site. Click here to view / download the PDF file. The guidelines were also formally published in Nuclear Medicine Communications in August 2004 (Fleming JS et al, Guidelines for the measurement of glomerular filtration rate using plasma sampling. Nucl Med Commun 2004: 25: 759-769).
A review of the BNMS GFR guidelines is underway and new guidelines should be published in 2017.
Please send any suggestions or ideas for things that need clarification to me at firstname.lastname@example.org
An Excel spreadsheet for GFR data analysis
The NMC editorial mentioned above refers to the availability of three user-written spreadsheets for analysis of GFR data that should make it easier for users to implement the new guidelines. One of these spreadsheets was developed here at Pilgrim Hospital, Boston....
Output screen from GFR spreadsheet
Version 1.0 was developed during 1999 and has been in routine clinical use at Pilgrim Hospital, Boston since then. It has been tested by colleagues in several UK departments.
It complies with the data input/output requirements of the BNMS GFR guidelines.
To view the program feature list click here. Now at version 5.5 (released January 2014).
A version (5.5b) is also available with built-in decay correction (during the counting period), which may be of interest to Tc99m DTPA users.
Any Windows PC (with a 17 inch monitor or better) capable of running Microsoft Excel version 2010 or later.
A monochrome laser printer.
Note: The software is not designed to
run on small-screen tablet computers.
Operating System: Any version of Microsoft Windows capable of running Excel 2010 or later. This includes Windows XP Professional, Windows 7 and Windows 8
The product has not yet been fully tested running in Windows 10, but it should work OK.
Excel for Windows: Excel 2010 or later. Current version of GFR spreadsheet (version 5.5) was developed using Excel 2010 so this is the recommended version of Excel to use.
You may need to some minor changes to your local MS Office 2010 security settings (ref: running macros). All is explained in the user manual.
The basic functions have been tested with Windows 10/Excel 2013, but more detailed testing is required before this newer version (of Excel) can be recommended in this context.
If you move from Excel 2010 to Excel 2013, it is recommended that you run at least 20 test cases (actual patient data) in order to compare results.
And include outputs produce by both
manual and automatic curve fitting.
Product availability and ongoing support
Contact the author for details. The product is not CE marked, so cannot currently be supplied for routine clinical use within the EU.
See recent guidance issued by IPEM’s ICSIG for regulatory information on ‘standalone’ medical software, including expected changes for medical device regulation in the UK.
It can be supplied for research use (as this is not covered by the UK Medical Device Regulations), but check the policy of your organisation before enquiring.
A trial (60 day evaluation) version of the full product is also available on request.
A specific ‘research version’ has also been developed that allows for the input of data from up to 13 blood samples over the 0-4 hr period, with integrated ‘curve peeling’ to resolve the two exponential components of the plasma disappearance curve.
I have now left the employ of United Lincolnshire Hospitals (as of Sept 2016) but intend to continue to support the product for at least another 12 months.
This includes any necessary error fixes, plus a more comprehensive upgrade if the BNMS guidelines are update during this time period.
Please note the change of email address given below.
Support may continue beyond that point but cannot be guaranteed.
It is therefore advisable to think about developing your own version, so that you can support it locally.
This program may become commercially available in due course, through collaboration with an established supplier, but there is no guarantee of this.
This page last updated: 2 September 2016.
Address for correspondence:
E-mail to email@example.com
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