phosphorus-radioisotopes and Kidney-Diseases

By definition, idiopathic erythrocytosis (IE) applies to a group of patients characterised by having a measured RCM above their predicted normal range (an absolute erythrocytosis) and following investigation do not have a form of primary or secondary erythrocytosis. Patients with IE are heterogenous. The possibilities include physiological variation, 'early' polycythaemia vera (10-15% develop clear features of PV over a few years), unrecognized congenital erythrocytosis, unrecognized or unrecognizable secondary acquired erythrocytosis or a currently undescribed form of primary or secondary erythrocytosis. Patients are more commonly male with a median age at presentation of 55-60 years. Approximately half of the patients present with vascular occlusive complications. Retrospective evidence indicates that vascular occlusion occurs less frequently when the PCV is controlled at normal levels. Venesection is the treatment of choice to lower the PCV. As a general approach to management, all patients with a PCV above 0.54 should be venesected to a PCV less than 0.45. This target PCV should also apply to patients with lesser degrees of raised PCV who have additional other risk factors for vascular occlusion.

Topics: Aged; Arterial Occlusive Diseases; Bone Marrow; Chlorambucil; Diagnosis, Differential; Endocrine System Diseases; Erythrocyte Volume; Erythroid Precursor Cells; Erythropoietin; Genetic Predisposition to Disease; Humans; Hypoxia; Kidney Diseases; Leukemia; Leukemia, Radiation-Induced; Middle Aged; Phosphorus Radioisotopes; Polycythemia; Polycythemia Vera; Receptors, Erythropoietin; Sequence Deletion; Smoking; Stroke

Topics: Anemia; Blood Volume; Carbon Radioisotopes; Cardiovascular Diseases; Chromium Radioisotopes; Chronic Disease; Endocrine System Diseases; Erythrocyte Volume; Female; Hematocrit; Humans; Kidney Diseases; Liver Cirrhosis; Lung Diseases; Male; Nutrition Disorders; Phosphorus Radioisotopes; Plasma Volume; Polycythemia; Pregnancy; Technetium; Time Factors

In normal adults, the maintenance of phosphate balance involves the reabsorption of 85-90% of filtered phosphate by the proximal tubule. At a glomerular filtration rate (GFR) of 125 ml min-1 and a plasma phosphate concentration of 1.3 mmol l-1, the filtered phosphate is approximately 235 mmol day-1. Following intravenous administration, 25-50% of 32P is excreted over 4-6 days in normal subjects. In spite of such extensive renal handling of phosphate and, therefore, of 32P, there are no data in the literature concerning possible 32P-related nephrotoxicity. Adult dosimetry values for the kidney after 32P are reported as 4.8 rad mCi-1 h-1 (0.048 mSev 37 MBq-1 h-1). The entry criteria for 32P therapy insist on a normal serum creatinine value, reflecting awareness of potential renal damage. To answer the fundamental question of whether there is demonstrable renal damage after 32P, we undertook serial measurements of GFR in patients given 32P for treatment of pain from skeletal metastases. Twenty-one patients who had normal pre-treatment renal function as shown by normal serum creatinine values were administered 32P orally in doses ranging from 277.5 to 466.2 MBq, with a mean of 425.5 MBq. Pre-treatment, GFR was estimated with 99Tcm-diethylenetriamine pentaacetate renography using the Gates protocol. Post-treatment, GFR was estimated serially as far as possible, at weeks, 1, 2, 3 and 4 and then every 4 weeks for another 3 months, at which point follow-up ceased. Serum creatinine was assessed pre-treatment and every 2 weeks until the end of follow-up, in addition to all other parameters and a clinical evaluation. Mean pre-treatment GFR was 87.5 ml min-1, with a range of 48.7-110 ml min-1. Not all patients could fulfil the entire follow-up schedule as designed, but we obtained a minimum of four follow-up tests, two before and two after 4 weeks post-treatment. GFR fell to 72% of the pre-therapy value during the first 4 weeks following therapy. By the sixteenth week, however, the mean value had returned to or exceeded the pre-treatment value. There was no change in serum creatinine values. At a time when multiple therapies are being considered, this early depression of GFR may be of importance. A closer assessment of altered renal function may be warranted and other sensitive tests of renal damage like microalbuminuria could be used.

Topics: Adult; Bone Neoplasms; Follow-Up Studies; Glomerular Filtration Rate; Humans; Kidney Diseases; Pain; Palliative Care; Phosphorus Radioisotopes; Time Factors

Topics: Blood Cell Count; Bloodletting; Diagnosis, Differential; Erythropoiesis; Erythropoietin; Hematocrit; Humans; Kidney Diseases; Lung Diseases; Oxygen; Phosphorus Radioisotopes; Polycythemia; Polycythemia Vera

This review covers the side effects and adverse reactions to radiopharmaceuticals that were reported in the literature over the past 25 years. The information published prior to 1970 is sporadic, but due to the increased utilization of nuclear medicine procedures and the recognition that radiopharmaceuticals may have pharmacologic side effects, a registry has existed since 1971 to tabulate information on such effects. This survey is medical, rather than pharmaceutical in emphasis and so the adverse reactions are classified according to the target-organ systems involved rather than according to the specific radionuclides or to pharmaceuticals. If any of the radiopharmaceuticals of present or past use are not mentioned in this review, it is because no reports on their side effects were retrived by us. Hopefully, the organized registry system suggested by the Society of Nuclear Medicine (SNM) will enable a more complete recording of side effects from radiopharmaceuticals in the future.

Topics: Bone Marrow; Brain Diseases; Colloids; Gold Colloid, Radioactive; Humans; Hyperthyroidism; Iodine Radioisotopes; Iron; Kidney Diseases; Liver Diseases; Lung Diseases; Meningitis; Peritoneum; Phosphorus Radioisotopes; Polycythemia Vera; Pyrogens; Radioisotopes; Radionuclide Imaging; Radiotherapy; Registries; Serum Albumin; Serum Albumin, Radio-Iodinated; Skin; United States; Xenon Radioisotopes

Topics: Blood Platelets; Buffers; Edetic Acid; Erythrocytes; Freezing; Glycerophosphates; Humans; Hydrogen-Ion Concentration; Kidney Diseases; Leukocytes; Liver Diseases; Lymphocytes; Lysosomes; Magnesium; Mercaptoethanol; Microsomes; Phosphates; Phospholipids; Phosphoric Monoester Hydrolases; Phosphorus Radioisotopes; Subcellular Fractions; Sulfhydryl Reagents; Temperature

Topics: Humans; Infarction; Kidney; Kidney Diseases; Phosphorus; Phosphorus Radioisotopes; Phosphorus, Dietary; Ureteral Diseases

Topics: Kidney Diseases; Kidney Function Tests; Phosphates; Phosphorus; Phosphorus Radioisotopes; Phosphorus, Dietary; Renal Elimination