succimer and Kidney-Tubular-Necrosis--Acute

This article describes the role of nuclear medicine in the evaluation of the genitourinary tract. The technical aspects of radionuclide imaging (radiopharmaceuticals, radiation dosimetry, instrumentation, and method) are briefly presented, and each of the indications for renal scintigraphy--including the evaluation of differential renal function, hypertension, obstruction, renal transplants, masses, trauma, congenital anomalies, vesicoureteral reflux, and infection--are discussed. The relative advantages and disadvantages of radionuclide imaging with respect to alternative radiographic examinations (such as intravenous urography, ultrasonography, CT, angiography, and magnetic resonance imaging) are emphasized wherever applicable.

Topics: Graft Rejection; Humans; Hypertension, Renovascular; Iodohippuric Acid; Kidney; Kidney Function Tests; Kidney Neoplasms; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Male; Organotechnetium Compounds; Pentetic Acid; Postoperative Complications; Pyelonephritis; Radioisotope Renography; Spermatic Cord Torsion; Succimer; Sugar Acids; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Ureteral Obstruction; Urinary Tract; Vesico-Ureteral Reflux

To design and establish a model to examine whether brief periods of renal artery occlusion (ischaemic preconditioning, IP) confers protection from the effects of a subsequent period of ischaemia and reperfusion of the rat kidney.. Ninety rats were randomized into six groups, i.e. sham-operated controls; IP alone; a 20 or 40 min period of left renal ischaemia (RI) alone; and IP followed by a 20 or 40 min period of RI. Preconditioning involved the sequential clamping of the left renal artery for 4 min and its release for 11 min, a total of four times, a 'critical interval' of 30 min before the ischaemic insult. Left renal tissue integrity was determined by dimercapto-succinic acid (DMSA) radionuclide imaging on a gamma-camera both immediately (day 0) and 2 and 9 days later. Acute tubular necrosis was also assessed histologically.. RI for 20 min resulted in a significant decrease in left renal tissue integrity on day 2 only (P < 0.001), whereas RI for 40 min caused significant left renal dysfunction on day 0, day 2 and day 9 (P < or = 0.01). For a given duration of ischaemia, there was no significant difference between results from (IP + RI) rats compared with RI-only rats at any of the three times. There was no significant alteration in renal tissue integrity in the IP-only rats compared with sham-operated controls. Histological findings paralleled the data obtained from DMSA uptake.. The IP regimen and 30 min 'critical interval' confers no protection to the kidney from a 20 or 40 min ischaemic episode. The IP regimen itself appears to have no effect, confirming the validity of our experimental model.

Topics: Animals; Constriction; Disease Models, Animal; Female; Ischemic Preconditioning; Kidney; Kidney Tubular Necrosis, Acute; Organotechnetium Compounds; Radiography; Radionuclide Imaging; Rats; Rats, Wistar; Renal Artery; Reperfusion Injury; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid

A 35-yr-old patient developed severe acute tubular necrosis requiring hemodialysis. A [99mTc]dimercaptosuccinic acid scan of the kidneys showed no renal uptake at 4 or 24 hr, but the patient subsequently recovered normal renal function as judged by a normal serum creatinine. Based on this case report and a review of the literature, one cannot assume irreversible loss of function in patients with acute renal failure, based on the absence of radiopharmaceutical uptake by the kidneys.

Topics: Acute Kidney Injury; Adult; Blood Urea Nitrogen; Creatinine; Female; Hemorrhage; Humans; Hysterectomy; Kidney; Kidney Tubular Necrosis, Acute; Postoperative Complications; Pregnancy; Puerperal Disorders; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Stomach; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid

The effect of transient renal ischemia on renal concentration and distribution of 99mTc-HEDP, 99mTc-DMSA, and 99mTc-DTPA was compared in rabbits with acute tubular necrosis. Scintigrams were obtained after injection in normal rabbits or ones with unilateral or bilateral ischemia. 99mTc-HEDP concentration in ischemic tissue was 8 to 18 times normal 1--4 hours after injection, and the resulting images delineated the morphological changes in the ischemic kidneys more accurately than those obtained with DMSA or DTPA. Calcium concentration in the ischemic kidneys increased sixfold. 99mTc-HEDP may be useful in evaluation of renal failure secondary to tubular injury.

Topics: Acute Kidney Injury; Animals; Calcium; Etidronic Acid; Female; Ischemia; Kidney; Kidney Tubular Necrosis, Acute; Male; Rabbits; Radionuclide Imaging; Succimer; Technetium