succimer and Renal-Artery-Obstruction

The diagnostic value of renal scintiscans in patients with acute or chronic renal failure has not been emphasized other than for the estimation of renal size. 131I OIH, 67gallium, 99mTcDTPA, glucoheptonate and DMSA all may be valuable in a variety of specific settings. Acute renal failure due to acute tubular necrosis, hepatorenal syndrome, acute interstitial nephritis, cortical necrosis, renal artery embolism, or acute pyelonephritis may be recognized. Data useful in the diagnosis and management of the patient with obstructive or reflux nephropathy may be obtained. Radionuclide studies in patients with chronic renal failure may help make apparent such causes as renal artery stenosis, chronic pyelonephritis or lymphomatous kidney infiltration. Future correlation of scanning results with renal pathology promises to further expand nuclear medicine's utility in the noninvasive diagnosis of renal disease.

Topics: Acute Kidney Injury; Adult; Aged; Embolism; Female; Gallium Radioisotopes; Humans; Iodine Radioisotopes; Iodohippuric Acid; Kidney Failure, Chronic; Kidney Neoplasms; Male; Middle Aged; Nephritis, Interstitial; Organotechnetium Compounds; Pentetic Acid; Pyelonephritis; Radionuclide Imaging; Renal Artery Obstruction; Succimer; Sugar Acids; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate

To examine the incidence, clinical and radiologic findings, and response to treatment of renovascular hypertension (RVHT) in moyamoya disease (MMD).. A retrospective analysis of medical records in six RVHT cases (8.3%) among 72 MMD patients observed from November 1987 to December 1995.. The age at onset of MMD ranged from 9 months to 7 years 1 month (mean, 3.3 years). The most common initial manifestation of MMD was transient ischemic attack. Hypertension was detected between 4 years 4 months and 12 years 3 months (mean, 7.87 years). Unstimulated plasma renin activity was elevated in all six cases. Renal ultrasonography and captopril technetium 99m-labeled dimercaptosuccinic acid scan showed abnormal findings in four of five and in three of four available studies, respectively. However, both imaging studies showed abnormal findings only in the most severely affected kidneys even with bilateral renal artery stenosis. Renal arteriography revealed bilateral lesions in three of the patients and unilateral lesions in the others. Renal angioplasty was performed in four cases but was successful in only one and partially successful in another. A renal artery specimen obtained during renal autotransplantation showed intimal fibroplasia. At the last follow-up, one patient had normal blood pressure without the use of antihypertensive agents, but the other five patients needed this medication to control blood pressure.. Because RVHT may be more commonly associated with MMD than has hitherto been appreciated, it is recommended that blood pressure be carefully followed and that diagnostic procedures for RVHT be carried out in hypertensive patients with MMD.

Topics: Adolescent; Angiography; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Biopsy; Blood Pressure; Captopril; Child; Child, Preschool; Female; Fibromuscular Dysplasia; Follow-Up Studies; Humans; Hypertension, Renovascular; Incidence; Infant; Ischemic Attack, Transient; Kidney; Kidney Transplantation; Male; Moyamoya Disease; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Renal Artery Obstruction; Renin; Retrospective Studies; Seizures; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Tunica Intima; Ultrasonography

Systemic lupus erythematosus (SLE) patients, specially those with antiphospholipid antibodies, have a high incidence of arterial and venous thrombotic manifestations. However, renal infarction has been rarely reported in these patients. The case of a young female with renal infarction, diagnosed by renal arteriography and scintigraphy, and arterial hypertension (AH) is described. In subsequent years she also suffered several cerebrovascular accidents with important neurological sequelae. No evidence of systemic disease was observed at this time. Fourteen years after the renal infarction a diagnosis of SLE was established. Despite therapy with prednisone, acetylsalicylic acid, azathioprine and antihypertensive drugs the progression of the neurological disease led to death. The sudden appearance of severe AH in a young woman with a renal infarction should alert the clinician about a possible underlying renal artery thrombosis in association with SLE and antiphospholipid antibodies.

Topics: Adult; Angiography; Antibodies, Antiphospholipid; Antiphospholipid Syndrome; Brain Ischemia; Fatal Outcome; Female; Humans; Hypertension; Infarction; Kidney; Lupus Erythematosus, Systemic; Radionuclide Imaging; Renal Artery Obstruction; Succimer; Thrombosis

Plasma endothelin-1 (ET-1)-like immunoreactivity in selective renal venous blood and peripheral venous blood was measured and compared with plasma renin activity and aldosterone level in a 26-year-old woman with suspected renovascular hypertension due to stenosis of the left renal artery. Although there was no significant step-up in plasma renin activity between the right and the left renal vein, left/right ratio of plasma ET-1 in the renal vein was 2.18. This case suggests that ET-1 may be one of the hypertensive mechanisms of suspected renovascular hypertension in addition to the renin-angiotensin system.

Topics: Adult; Aldosterone; Endothelins; Female; Humans; Hypertension, Renovascular; Kidney; Kidney Function Tests; Organotechnetium Compounds; Radioimmunoassay; Radionuclide Imaging; Renal Artery Obstruction; Renin; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid

Captopril-enhanced renal scintigraphy with Tc-99m DMSA was performed in an 11-year-old boy with hypertension. This showed a significant reduction in function of the right kidney. Renal arteriography was performed and showed two renal arteries on the right, the major one with stenosis. This case illustrates the possible role that scintigraphy with Tc-99m DMSA can play in the diagnosis of renovascular hypertension.

Topics: Captopril; Child; Humans; Hypertension, Renovascular; Kidney; Male; Organotechnetium Compounds; Radiography; Radionuclide Imaging; Renal Artery; Renal Artery Obstruction; Sensitivity and Specificity; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid

In 14 in situ canine renal transplants, intracellular phosphorus metabolites were evaluated by phosphorus-31 magnetic resonance spectroscopy (31P-MRS), performed using surface coils to investigate the usefulness of this technique for assessing renal viability in situ. Group I control kidneys (n = 5) were autografts, as were Group II (n = 5) kidneys: the latter group were subjected to surgically induced vascular ischemia and thrombosis. Group III kidneys (n = 4) were rejecting allografts. Renal flow and function, as measured by 99mTc-DTPA, and findings on histologic examination were correlated with 31P-MRS spectra. Group I kidneys showed excellent viability on both 99mTc-DTPA studies and biopsy evaluation, and their 31P-MRS-derived ratios of phosphomonoesters/inorganic phosphate (PME/Pi) and adenosine triphosphate/Pi (ATP/Pi) were high (1.32 +/- 0.23 and 0.90 +/- 0.36, respectively). In contrast, Group II kidneys demonstrated poor flow and function, histologic evidence of severe ischemia from venous and arterial thrombosis, and significantly (P < 0.005) less viability than controls, as monitored by 31P-MRS PME/Pi (0.58 +/- 0.30) and ATP/Pi (0.20 +/- 0.13) ratios. Group III kidneys also demonstrated poor flow and function with 99mTc-DTPA, and the associated histologically injury was noted to be caused by accelerated rejection and severe vascular damage. PME/Pi (0.24 +/- 0.22) and ATP/Pi (0.10 +/- 0.01) ratios were also significantly (P < 0.005) less than those in controls, reflecting nonviability. The 31P-MRS-derived PME/Pi and ATP/Pi ratios enable a qualitative noninvasive assessment of blood flow-dependent renal viability, but with currently used localization techniques the differentiation between severe ischemia and severe acute rejection was not possible.

Topics: Adenosine Triphosphate; Animals; Dogs; Graft Rejection; Graft Survival; Kidney; Kidney Transplantation; Magnetic Resonance Spectroscopy; Organotechnetium Compounds; Phosphates; Renal Artery Obstruction; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Thrombosis

This is a report of serial Tc-99m DMSA renal imaging on a pediatric patient with renovascular hypertension that experienced a complication of angioplasty. The case dramatically illustrates the usefulness of this radiopharmaceutical in the evaluation of acutely worsening hypertension, and in monitoring improvement following arterial revascularization for significant branch stenosis.

Topics: Angioplasty, Balloon; Child; Humans; Hypertension, Renovascular; Kidney; Male; Organotechnetium Compounds; Radionuclide Imaging; Renal Artery; Renal Artery Obstruction; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid

Iodine-123 hippurate renography, [99mTc]diethylenetriaminepentaacetic acid (DTPA) renography, and [99mTc]dimercapto succinic acid (DMSA) renal scintigraphy were performed before and during angiotensin converting enzyme (ACE) inhibition in a group of 15 hypertensive patients with angiographically "significant" unilateral renal artery stenosis. Visual and quantitative evaluation of the three radioisotope methods before ACE inhibition already disclosed abnormalities suggestive of renal artery stenosis in a high percentage (87%, 60%, and 60%, respectively) in this group of patients, but ACE inhibition further improved the diagnostic yield in all three methods (93%, 86%, and 80%). Iodine-123 hippurate renography was at least as useful as [99mTc]DTPA renography in this respect, while [99mTc]DMSA scintigraphy can be used particularly in segmental stenosis. Despite a large drop in blood pressure after ACE inhibition little adverse reactions were seen and overall renal function was fairly well maintained, the exceptions noted in patients with initially a more impaired renal function.

Topics: Adolescent; Adult; Angiotensin-Converting Enzyme Inhibitors; Blood Pressure; Drug Evaluation; Enalapril; Female; Humans; Hypertension, Renovascular; Iodohippuric Acid; Kidney; Male; Middle Aged; Organometallic Compounds; Pentetic Acid; Radionuclide Imaging; Renal Artery Obstruction; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate

Topics: Aortography; Humans; Male; Middle Aged; Organometallic Compounds; Radionuclide Imaging; Renal Artery Obstruction; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid

A patient is described who had accelerated hypertension and unilateral renal artery stenosis, and who developed further deterioration in renal function during treatment with captopril, an angiotension-I (AI) converting-enzyme inhibitor. 99mTc-DMSA uptake was greatly diminished in the stenotic kidney, although renal blood flow and handling of 131I-hippurate was preserved. Uptake of 99mTc-DMSA in the affected kidney returned after substitution of captopril by the vasodilator minoxidil, while a comparable degree of blood pressure control was maintained. Thus, caution must be taken when interpreting results of 99mTc-DMSA scintigraphy in patients with proven or suspected renal artery stenosis treated with an AI converting-enzyme inhibiting drug. Moreover, our finding points to the importance of glomerular filtration in the renal handling of 99mTc-DMSA.

Topics: Angiotensin-Converting Enzyme Inhibitors; Captopril; Glomerular Filtration Rate; Humans; Iodine Radioisotopes; Iodohippuric Acid; Kidney; Male; Middle Aged; Radionuclide Imaging; Renal Artery Obstruction; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid

Abnormal increased renal accumulation of Tc-99m-MDP was observed in a patient found subsequently to have stenosis of the ipsilateral renal artery. The case is both interesting in itself and for its possible implications regarding the use of radiolabeled phosphates in renal ischemia.

Topics: Aged; Diphosphonates; Humans; Iodohippuric Acid; Male; Radionuclide Imaging; Renal Artery Obstruction; Succimer; Technetium