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      A Simplified Iohexol-Based Method to Measure Renal Function in Sheep Models of Renal Disease

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          Abstract

          Sheep are highly adequate models for human renal diseases because of their many similarities in the histology and physiology of kidney and pathogenesis of kidney diseases. However, the lack of a simple method to measure glomerular filtration rate (GFR) limits its use as a model of renal diseases. Hence, we aimed to develop a simple method to measure GFR based on the plasma clearance of iohexol by assessing different pharmacokinetic models: (a) CL2: two-compartment (samples from 15 to 420 min; reference method); (b) CL1: one-compartment (samples from 60 to 420 min); (c) CLl f: CL1 adjusted by a correction formula and (d) SM: simplified CL2 (15 to 300 min). Specific statistics of agreement were used to test the models against CL2. The agreement between CL1 and CL2 was low, but both CL1 f and SM showed excellent agreement with CL2, as indicated by a total deviation index of ~5–6%, a concordance correlation of 0.98–0.99% and a coverage probability of 99–100%, respectively. Hence, the SM approach is preferable due to a reduced number of samples and shorter duration of the procedure; two points that improve animal management and welfare.

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          STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT

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            Iohexol plasma clearance for measuring glomerular filtration rate in clinical practice and research: a review. Part 1: How to measure glomerular filtration rate with iohexol?

            While there is general agreement on the necessity to measure glomerular filtration rate (GFR) in many clinical situations, there is less agreement on the best method to achieve this purpose. As the gold standard method for GFR determination, urinary (or renal) clearance of inulin, fades into the background due to inconvenience and high cost, a diversity of filtration markers and protocols compete to replace it. In this review, we suggest that iohexol, a non-ionic contrast agent, is most suited to replace inulin as the marker of choice for GFR determination. Iohexol comes very close to fulfilling all requirements for an ideal GFR marker in terms of low extra-renal excretion, low protein binding and in being neither secreted nor reabsorbed by the kidney. In addition, iohexol is virtually non-toxic and carries a low cost. As iohexol is stable in plasma, administration and sample analysis can be separated in both space and time, allowing access to GFR determination across different settings. An external proficiency programme operated by Equalis AB, Sweden, exists for iohexol, facilitating interlaboratory comparison of results. Plasma clearance measurement is the protocol of choice as it combines a reliable GFR determination with convenience for the patient. Single-sample protocols dominate, but multiple-sample protocols may be more accurate in specific situations. In low GFRs one or more late samples should be included to improve accuracy. In patients with large oedema or ascites, urinary clearance protocols should be employed. In conclusion, plasma clearance of iohexol may well be the best candidate for a common GFR determination method.
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              Statistical Methods in Assessing Agreement

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                Author and article information

                Journal
                Biology (Basel)
                Biology (Basel)
                biology
                Biology
                MDPI
                2079-7737
                31 August 2020
                September 2020
                : 9
                : 9
                : 259
                Affiliations
                [1 ]Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz, 28040 Madrid, Spain; sergio.lima@ 123456quironsalud.es (S.L.-L.); AOrtiz@ 123456fjd.es (A.O.)
                [2 ]Dpto. de Produccion y Sanidad Animal, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities, C/Tirant lo Blanc, 7, 46115 Alfara del Patriarca Valencia, Spain; carolina.mas@ 123456alumnos.uchceu.es (C.M.-S.); paula.martinez@ 123456uchceu.es (P.M.-R.)
                [3 ]Research Unit, Hospital Universitario de Canarias, 38320 La Laguna, Tenerife, Spain; anarrguez@ 123456gmail.com (A.E.R.-R.); lauradiazmart@ 123456gmail.com (L.D.-M.); ajimenezsosa@ 123456gmail.com (A.J.-S.)
                [4 ]Internal Medicine Department, Hospital Universitario de Canarias, 38320 La Laguna, Tenerife, Spain; esteban.l.porrini@ 123456gmail.com
                [5 ]Laboratorio Función Renal, Universidad de La Laguna, 38320 La Laguna, Tenerife, Spain; flagas52@ 123456gmail.com
                [6 ]Department of Pharmacy, University of Oslo, 0316 Oslo, Norway; anders.asberg@ 123456farmasi.uio.no
                [7 ]Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, 0424 Oslo, Norway; trond.jenssen@ 123456ous-hf.no
                [8 ]Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria (INIA), Avda Pta. de Hierro s/n, 28040 Madrid, Spain
                Author notes
                [* ]Correspondence: bulnes@ 123456inia.es ; Tel.: +34-913-474-022
                Author information
                https://orcid.org/0000-0003-3540-8252
                https://orcid.org/0000-0002-0803-864X
                https://orcid.org/0000-0002-9805-9523
                https://orcid.org/0000-0002-0628-1769
                https://orcid.org/0000-0001-6602-8274
                https://orcid.org/0000-0001-8732-2616
                https://orcid.org/0000-0002-0917-4475
                Article
                biology-09-00259
                10.3390/biology9090259
                7564881
                32878167
                c60c1cb9-8947-4c99-962b-c44052672dbe
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 21 July 2020
                : 26 August 2020
                Categories
                Article

                renal function,iohexol plasma clearance,sheep model
                renal function, iohexol plasma clearance, sheep model

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