succimer and Ureteral-Obstruction

Topics: Algorithms; Animals; Female; Follow-Up Studies; Humans; Hydronephrosis; Infant, Newborn; Male; Pyelonephritis; Succimer; Tomography, Emission-Computed, Single-Photon; Ultrasonography; Ureteral Obstruction

Over the past 10 years new imaging and interventional techniques have drastically changed the ease and scope of urologic diagnosis and treatment. It is both rewarding and exciting to approach each clinical problem with a broad armamentarium of available studies, always seeking the most efficient and direct route to diagnosis. Similarly, radiologic interventional techniques are potentially applicable to a multitude of problems and should be innovatively considered in the urologic patient including patients in the pediatric age group.

Topics: Abscess; Child; Child, Preschool; Female; Humans; Hydronephrosis; Ileum; Infant; Iodohippuric Acid; Kidney; Kidney Diseases; Male; Pentetic Acid; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Tomography, X-Ray Computed; Ultrasonography; Ureteral Obstruction; Urethra; Urinary Bladder; Urinary Calculi; Urinary Diversion; Urologic Diseases; Vesico-Ureteral Reflux

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 determine the diagnostic accuracy of spot urine creatinine concentration (UCC) as a new test for the evaluation of differential renal function in obstructed kidneys (DRF(ok)) drained by percutaneous nephrostomy tube (PCNT).. In patients with obstructed kidneys drained by PCNT, DRF(ok) was derived from UCC by comparing the value of UCC in the obstructed kidney to the value in the contralateral kidney, and was derived from dimercaptosuccinic acid (DMSA) renal scans and creatinine clearance (CCr) using standard methods. Subsequently, the results of UCC were compared to the results of DMSA and CCr.. 61 patients were enrolled. Bland-Altman plots to compare DMSA and UCC showed that the upper limit of agreement was 14.8% (95% CI 10.7-18.5) and the lower limit was -19.9% (95% CI -23.8 to -16.1). The sensitivity and specificity of detecting DMSA DRF(ok) < or = 35% using UCC was 85.2 and 91.2%, respectively. When UCC was compared to CCr, Bland-Altman tests gave an upper limit of agreement of 10.4% (95% CI 7.9-12.8) and a lower limit of agreement of -11.3% (95% CI -13.8 to -8.9).. UCC is accurate in the estimation of DRF(ok) drained by PCNT.

Topics: Adult; Creatinine; Female; Humans; Kidney; Male; Nephrostomy, Percutaneous; Radionuclide Imaging; Reproducibility of Results; Succimer; Ureteral Obstruction

The accumulation of radioactivity in the dilated collecting system potentially influences the calculation of differential renal function on the radionuclide test. We focused on this reservoir effect in unilateral hydronephrosis and assessed the reliability of calculating differential renal function by dimercapto-succinic acid (DMSA) uptake 2 hours after injection.. Unilateral partial ureteral obstruction was created in 8-week-old rats. Four weeks after surgery the animals were sacrificed 2 and 24 hours after the injection of tracer. The DMSA uptake rates of the renal parenchyma and collecting system were measured separately by autowell gamma counter. Differential function was calculated according to renal parenchymal and whole kidney (parenchyma and collecting system) uptake.. There was a higher accumulation of DMSA in the dilated renal pelvis at 2 than at 24 hours. However, DMSA uptake in the collecting system was extremely small in comparison to that in the parenchyma. As a result; differential renal function calculated using parenchymal uptake was similar to that calculated using whole kidney uptake measured 2 and 24 hours after injection.. Our data suggest that the pure reservoir effect of DMSA uptake at early measurement is much smaller than reported in previous experimental animal studies. Further clinical studies are needed to reexamine this reservoir effect in children with unilateral hydronephrosis.

Topics: Animals; Hydronephrosis; Injections; Organotechnetium Compounds; Rats; Rats, Sprague-Dawley; Reproducibility of Results; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Time Factors; Ureteral Obstruction

We evaluated whether increased differential renal function on the pentetic acid (DTPA) renogram represents elevated renal function in obstructed kidneys.. In 10 patients with unilateral ureteropelvic junction obstruction and a differential function of 53% or greater on the DTPA renogram of the obstructed kidney we performed quantitative single photon emission computerized tomography of dimercapto-succinic acid uptake by the kidneys.. The absolute uptake of dimercapto-succinic acid was significantly higher in the obstructed kidneys compared to the contralateral normal kidneys (30.0% +/- 7.8 versus 25.3% +/- 8.2, t = 3.6, p < 0.01, respectively). The elevated absolute uptake in the obstructed kidneys was due to an increased functional volume compared to the contralateral normal kidneys (126.0 +/- 69.7 cc versus 102.3 +/- 59.2 cc, t = 4.4, p < 0.01, respectively).. The results suggest that increased relative renal function in hydronephrotic kidneys due to ureteropelvic junction obstruction is not an artifact of the DTPA renogram. It may represent a compensatory mechanism that sometimes may overcompensate resulting in a paradoxical hyperfunctioning kidney.

Topics: Adult; Artifacts; Chelating Agents; Child; Child, Preschool; Female; Humans; Infant; Kidney Pelvis; Male; Radioisotope Renography; Succimer; Tomography, Emission-Computed, Single-Photon; Ureteral Obstruction

To assess the value of an ultrasound examination in children with a proven urinary tract infection.. The results of renal ultrasound and 99mTc-dimercapto-succinic acid (DMSA) studies were compared in 112 children with a first documented symptomatic Escherichia coli urinary tract infection.. Ultrasound was particularly effective in detecting the presence of obstruction, renal swelling and parenchymal change consistent with acute pyelonephritis. However, ultrasound failed to detect half of the kidneys with photon deficient areas on 99mTc DMSA scan and was unreliable in detecting the presence of scarring.. An ultrasound examination alone should not be relied on in the child with an acute urinary tract infection.

Topics: Adolescent; Child; Child, Preschool; Escherichia coli Infections; Female; Humans; Infant; Kidney Diseases; Male; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ultrasonography; Ureteral Obstruction; Urinary Tract Infections

Single kidney glomerular filtration rate (SK GFR), single kidney blood flow (SK BF) and differential renal function (DRF), using both technetium labelled diethylene-pentaacetic acid (99mTc-DTPA) and dimercaptosuccinic acid (99mTc-DMSA), were examined as predictors of outcome in a pig model of complete unilateral ureteric obstruction. SK GFR and SK BF were unable to predict outcome following relief of obstruction but there was a high curvilinear correlation between DRF assessed at the end of defined periods of obstruction and after relief of obstruction using 99mTc-DMSA. Functional recovery was near complete using DMSA when the loss in DRF did not exceed 30%, after which there was an exponential decline in expected recovery. There was no difference between DRF using 99mTc-DTPA or 99mTc-DMSA in controls or before or after obstruction but significant differences between assessment by these radionuclides existed in the obstructed kidney at 24 h, 5 days, 10 days and 20 days. 99mTc-DMSA is a sensitive agent in the prediction of outcome following acute complete obstruction in the pig but its assessment of DRF in the obstructed kidney differs markedly from that of 99mTc-DTPA.

Topics: Animals; Disease Models, Animal; Glomerular Filtration Rate; Kidney; Organotechnetium Compounds; Renal Circulation; Succimer; Swine; Swine, Miniature; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Treatment Outcome; Ureter; Ureteral Obstruction

The use of 99Tcm-mercapto acetyl triglycine (99Tcm-MAG3), a new hippuran substitute, has been reported widely in adults but not in children. Our experience of its use in 100 infants and children for renography and indirect micturating cystography (IMC) is reported. The average age was 5.6 years. 65 patients completed IMC studies and nine patients had 99Tcm-dimercaptosuccinic acid (99Tcm-DMSA) scans performed on the same day. The majority of patients were referred for the investigation of urinary tract infection. 32 kidneys were found to be scarred on 99Tcm-MAG3 scans, 17 kidneys and ureters refluxed on IMC and 14 kidneys were obstructed. The results of 99Tcm-MAG3 scans were compared with those of other urinary tract investigations including ultrasound, micturating cystography (MCUG), intravenous urography (IVU) and 99Tcm-DMSA scintigraphy. No kidney which was scarred had a normal 99Tcm-MAG3 scan. All significant degrees of dilatation or obstruction on IVU or ultrasound were also detected by 99Tcm-MAG3. 99Tcm-MAG3 gave more information than any other single imaging modality and we believe it represents an ideal initial screening test in the investigation of urinary tract infection in older toilet-trained children.

Topics: Adolescent; Child; Child, Preschool; Cicatrix; Humans; Infant; Infant, Newborn; Kidney; Kidney Diseases; Kidney Pelvis; Organotechnetium Compounds; Radionuclide Imaging; Sensitivity and Specificity; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Mertiatide; Ureter; Ureteral Obstruction; Urinary Bladder; Urination; Urography

Dismembered pyeloplasty was done on 12 renal units for ureteropelvic junction obstruction. Postoperatively, response of repaired kidney to standard diuretic dose of furosemide (0.3 mg/kg) was evaluated. Also renal pelvic pressures at rest and during diuresis were measured. All renal units responded to the diuretic by increasing their urine output an average of three times over baseline value. Renal pelvic pressure registration revealed no significant change after diuresis over baseline values. Diuretic technetium-99 DTPA renal scans were obtained two to six months postoperatively and compared with preoperative scans; the best results were obtained in renal units whose intrapelvic pressures did not exceed 10 cm of water in the immediate postoperative period.

Topics: Female; Furosemide; Humans; Infant; Kidney; Kidney Pelvis; Male; Middle Aged; Nephrostomy, Percutaneous; Organotechnetium Compounds; Radioisotope Renography; Stents; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Ureteral Obstruction; Urine; Urodynamics

This preliminary study examined reno-vascular injury sustained by the multipapillary porcine kidney in acute and chronic complete ureteric obstruction. In combination with measurement of upper tract pressure, regional function was assessed by [99mTc]-dimercaptosuccinic acid (DMSA) uptake and qualitative renal perfusion, by resin casting of the arterial tree prior to scanning electron microscopy (SEM). In acute obstruction, segmental defects were noted in the renal poles on both [99mTc]-DMSA scanning and casting. On SEM there was a polar afferent arteriolar vasodilatation after 30 min of obstruction and, subsequently, a segmental reduction in cortical perfusion. In kidneys that had been obstructed for 20 days, we observed a marked reduction in outer cortical perfusion coincident with afferent arteriolar vasoconstriction. The pathogenesis and significance of segmental injury to the multipapillary kidney in obstructive uropathy is discussed.

Topics: Animals; Arterioles; Kidney; Microscopy, Electron, Scanning; Organotechnetium Compounds; Radionuclide Imaging; Renal Artery; Renal Circulation; Succimer; Swine; Swine, Miniature; Technetium Tc 99m Dimercaptosuccinic Acid; Ureteral Obstruction

The renal function of sixty one adult patients was monitored by 99mTc-DMSA renal scan after cystectomy for a malignant tumour followed by ileal conduit urinary diversion. The postoperative follow-up period was 10 years. The stenosis rate of the uretero-ileal anastomosis was 12.8% and the incidence of pyelonephritis was 8% The mean value for overall renal function and for the function of each kidney did not deteriorate significantly (p = 0.1 and p = 0.7, respectively) over time. However, 26% of kidneys evaluated at 1 year and at 5 years showed a markedly decreased uptake on the renogram. In 70% of cases, this decreased uptake was related to the development of stenosis of the uretero-ileal anastomosis or pyelonephritis. Renal function remained stable at 5 years in group A, corresponding to patients with good initial renal function (n = 22, p = 0.07), and in group B, corresponding to patients with poor initial renal function (n = 7, p = 0.9). Similarly, the function of solitary kidneys did not deteriorate over the 5-year postoperative follow-up period (n = 7, p = 0.5). The functional value of the kidneys was therefore not globally altered after ileal conduit urinary diversion. The existence of a mechanical or infectious complication should be systematically investigated in the presence of a deterioration in renal function. DMSA isotope renal scan is a complete, qualitative and quantitative, follow-up examination after this type of urinary diversion.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Ileum; Incidence; Kidney Function Tests; Male; Middle Aged; Organotechnetium Compounds; Postoperative Complications; Pyelonephritis; Radionuclide Imaging; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ureteral Obstruction; Urinary Diversion

Urinary LMOX concentration was studied in 18 patients with unilateral ureteral obstruction. The concentration of LMOX in the urine from the mild obstructed kidney was 124 to 2,140 micrograms/ml and 10 micrograms/ml in the severely obstructed ones. The difference was probably due to the intensity and the duration of the obstruction. The patient with 99mTc-DMSA renal uptake of less than 3% also had a urinary LMOX concentration of less than 7 micrograms/ml. The above results seem to show that 7 micrograms/ml in urinary LMOX concentration is a significant figure for treatment of UTI. 99mTc-DMSA renal uptake and renal echogram were used to estimate the excretion rate of antibiotics into the urine.

Topics: Adolescent; Adult; Aged; Humans; Infusions, Intravenous; Kidney; Middle Aged; Moxalactam; Organotechnetium Compounds; Radioisotope Renography; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Ureteral Calculi; Ureteral Obstruction

Twelve Yucatan micropigs (3 controls; 3 sham-operated; 6 with unilateral obstruction) were studied to assess the value of noncontrast and contrast-enhanced (Gadolinium-DTPA) magnetic resonance (MR) imaging in the evaluation of partial ureteral obstruction. MR findings were correlated with findings of quantitative (Tc-99m-DMSA) scintigraphy, and histology. On noncontrast T1-weighted images, the normal porcine kidney demonstrated good corticomedullary contrast (CMC = 16.8% +/- 5.0). Five minutes after administration of Gd-DTPA, there was enhancement of the renal cortex (+24.4% and medulla (+46.2%), and CMC was no longer discernible. Enhancement of the urine within the collecting system (+119.1%) was also observed. The obstructed kidneys demonstrated marked thinning of the renal parenchyma and decreased signal intensity on noncontrast T1- and T2-weighted images (P less than 0.01). Urine in the dilated collecting system did not differ significantly from urine in controls except in the three animals with urinary tract infection (P less than 0.05). Five minutes following injection of Gd-DTPA, there was enhancement of the renal parenchyma in all kidneys. Excretion was seen in three pigs and no excretion in two. Thus, useful information can be obtained in partial ureteral obstruction from both pre-contrast and Gd-DTPA-enhanced MR images of the kidney.

Topics: Animals; Chronic Disease; Contrast Media; Gadolinium DTPA; Kidney; Kidney Cortex; Kidney Medulla; Kidney Pelvis; Magnetic Resonance Imaging; Organometallic Compounds; Pentetic Acid; Radionuclide Imaging; Succimer; Swine; Swine, Miniature; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Ureteral Obstruction

During a 1.5 year period 21 children were investigated with 99-m-technetium dimercaptosuccinic acid (DMSA) before operation for hydronephrosis due to pelviureteric obstruction. The age at investigation was 0.2-11.5 years. Fourty-two kidneys were examined. Hydronephrosis existed on the right side in 8 cases, left side in 9 and bilateral in 4 cases. Seventeen kidneys had no obstruction. The scintigraphy was interpreted as normal in 19 kidneys. Decreased isotope uptake was found in 23 kidneys and localized to the upper pole area in 19 kidneys, middle-lateral part in 7, lower pole area in 15 and the middle-medial part in 12 kidneys. There were no predominance for any part of the kidney to be affected by parenchymal damage. In 8 children investigated before the age of 1 year, 4 of 10 hydronephrotic kidneys revealed normal DMSA scintigram. DMSA scintigraphy delineates functioning renal parenchyma. DMSA scintigraphy delineates functioning renal parenchyma. It can be recommended as a routine method for evaluation of the renal parenchyma before surgery and for follow up studies in all ages of childhood.

Topics: Child; Child, Preschool; Female; Humans; Hydronephrosis; Infant; Kidney; Male; Organometallic Compounds; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Ureteral Obstruction

Partial obstruction of the left ureter was created in two-day-old rats and its effects on kidney function were studied with 99mTc-DMSA and 99mTc-DTPA after one, two, three and six weeks, and after one year. Kidneys from animals sacrificed at the age of six weeks or one year were also examined histologically. The obstructed renal pelvis was enlarged by about 35 times and there was a delayed excretion of 99mTc-DTPA during forced diuresis, indicating significant, chronic obstruction. The renal DMSA-uptake ratio (left kidney/(left and right kidney] was reduced to about 40% from the first week of obstruction. The parenchymal weight ratio (expressed as above) was reduced to about 45% after both six weeks and one year. The glomerular filtration rate, examined during forced diuresis and calculated on the basis of uptake capacity, was lowered to 42% after six weeks but was not significantly reduced after one year of obstruction. The incidence figures for medullary hemorrhage or accumulation of iron pigment, and chronic inflammatory changes in the cortex were somewhat higher after one year of obstruction than after 6 weeks, but the lesions were patchy in both groups. We conclude that partial unilateral ureteric obstruction, created in the neonatal period, leads to a slight but permanent functional disturbance and parenchymal weight reduction without prominent structural parenchymal damage.

Topics: Animals; Animals, Newborn; Follow-Up Studies; Hydronephrosis; Kidney; Organotechnetium Compounds; Pentetic Acid; Radioisotope Renography; Rats; Rats, Inbred Strains; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Time Factors; Ureteral Obstruction

The relative function of the obstructed kidney (RFOK) was assessed in 43 adult patients with upper urinary tract obstruction (UUTO) using 99mTc-DTPA and 131I-ortho-iodohippurate (OIH) dynamic studies and 99mTc-DMSA dynamic and static studies. The patients were divided into five groups according to the duration and degree of obstruction. Findings were as follows: a) in patients with the first occurrence of acute severe obstruction (group 1), the relative glomerular filtration rate (GFR) was significantly less than the relative effective renal plasma flow (ERPF); b) in patients with chronic severe obstruction and long term uroinfection, the relative ERPF decreased significantly compared with the relative GFR; c) the RFOK calculated from the DMSA dynamic study was the same as both the relative GFR or ERPF in any group; d) the RFOK calculated from the DMSA static study seemed to parallel the relative ERPF more closely than the relative GFR, but in group one it was significantly higher than any of three other estimates. It is concluded that 99mTc-DTPA is the radiopharmaceutical of choice in obstructive uronephropathy, but when interpreting the RFOK, the time course and severity of obstruction, the presence or absence of uroinfection should also be considered.

Topics: Adult; Aged; Female; Glomerular Filtration Rate; Humans; Iodohippuric Acid; Kidney; Male; Middle Aged; Organometallic Compounds; Pentetic Acid; Radionuclide Imaging; Renal Circulation; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Ureteral Obstruction

Phosphorus-31 magnetic resonance (MR) spectroscopy was used to study the effects of partial and complete ureteral obstruction on the porcine kidney; results were compared with renal tubular function as determined with technetium-99m dimercaptosuccinic acid (DMSA) scintigraphy. Twenty-seven pigs were used: nine as sham-operated controls, six with partial ureteral obstruction, and 12 with complete ureteral obstruction. P-31 MR spectra and Tc-DMSA scintiscans were obtained weekly over 3 weeks. Partial obstruction caused no significant change in P-31 MR spectra, whereas Tc-DMSA scintiscans showed a 74% decrease in tubular function by the end of 3 weeks. Complete obstruction caused a 43% reduction in the mean adenosine triphosphate (ATP) to inorganic phosphate (Pi) ratio, which paralleled the 96% decrease in Tc-DMSA uptake over 3 weeks. The difference in ATP/Pi ratios between control and completely obstructed kidneys was significant (P less than .01) at 2 and 3 weeks after ligation. These results indicate that radionuclide Tc-99m DMSA uptake is very sensitive to the pathophysiologic changes in renal tubular function, while the organ average cellular bioenergetic state (ATP/Pi) is not as strongly affected.

Topics: Adenosine Triphosphate; Animals; Kidney; Kidney Diseases; Kidney Tubules; Magnetic Resonance Spectroscopy; Organometallic Compounds; Phosphates; Radionuclide Imaging; Succimer; Swine; Swine, Miniature; Technetium Tc 99m Dimercaptosuccinic Acid; Ureteral Obstruction

We reviewed 59 cases of ureteropelvic junction obstruction diagnosed in 55 fetuses by echographic examination during prenatal period between 1981 and 1987. Postnatal excretory urograms and voiding cysto urethrography were obtained in all patients. Quantitative renal scans with 99 m technetium labeled dimercaptosuccinic acid or 99 m technetium labeled diethylenetriamine penta acetic acid were used in 49 patients and demonstrated a renal impairment in 19 cases (38%). 8 neonates were not operated, 1 required unilateral nephrectomy and 50 were treated by the Anderson-Hynes surgical procedure. 46 (92%) among those 50 obtained a significant improvement of pelvi-caliceal dilatation or excretion; 4 (8%) only a stabilisation. Early recognition of congenital hydronephrosis is now very common. After birth renal scans provided better estimation of renal function than excretory urograms but for the graduation of the obstruction the data did not appear to be always reliable (10% of false negatives in this study). The real problem is to know within which period of time the neonates whose renal function is impaired need surgery. In our study that question cannot be given a definitive answer because of too few post operative renal scans. However, we think, just as literature data tend to prove, that those neonates required early surgery if normal renal function is to be obtained.

Topics: Female; Fetal Diseases; Humans; Hydronephrosis; Infant, Newborn; Kidney Pelvis; Organometallic Compounds; Pentetic Acid; Pregnancy; Prenatal Diagnosis; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Ultrasonography; Ureteral Obstruction; Urography

Topics: Creatinine; Humans; Kidney Concentrating Ability; Kidney Function Tests; Metabolic Clearance Rate; Pentetic Acid; Radionuclide Imaging; Succimer; Ureteral Obstruction; Urinary Diversion

Although several authors have claimed that the function of an obstructed kidney could be overestimated on Tc-99m DMSA imaging, the clinical importance of such an overestimation has not been well documented. Partial obstruction of one ureter was created in a rat, and a relative Tc-99m DMSA uptake was obtained 4 hours after intravenous injection. By puncture of the isolated obstructed kidney, it was shown that the function of that kidney was overestimated by at least 17%.

Topics: Animals; Kidney; Radioisotope Renography; Rats; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Ureteral Obstruction

Topics: Adolescent; Adult; Child; Child, Preschool; Female; Humans; Infant; Kidney; Male; Middle Aged; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Ureteral Obstruction

An abnormal filtration fraction or a significant divergence between a kidney's ability to extract Tc-99m dimercaptosuccinic acid (DMSA) and other function parameters, such as the glomerular filtration rate (GFR) or the effective renal plasma flow (ERPF), could lead to different estimates of relative or absolute renal function, depending on the radiopharmaceutical administered. To evaluate this possible divergence, we measured the relative GFR (I-125 iothalamate), ERPF (I-131 hippurate), and Tc-99m DMSA accumulation in adult male Sprague-Dawley rats with unilateral ureteral obstruction or unilateral ischemia at various times after renal injury. The relative ERPF of the obstructed kidney was significantly greater than the relative GFR at all time periods studied; significant but less dramatic differences were noted comparing DMSA with GFR in obstruction and DMSA and ERPF with GFR in ischemia. In evaluating renal disease, it is important to consider the functional parameter reflected by the administered radiopharmaceutical as well as the underlying disease state.

Topics: Animals; Glomerular Filtration Rate; Hippurates; Iodine Radioisotopes; Iothalamic Acid; Ischemia; Kidney; Kidney Diseases; Male; Radioisotope Renography; Rats; Rats, Inbred Strains; Regional Blood Flow; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Ureteral Obstruction

Two hundred-two 99mTc-DMSA renograms for urologic problems were evaluated. Some technical aspects of the examination and the value of the scintigraphic depth estimation are discussed. Pre- and postoperative uptake values in patients with renal surgery and sequential postoperative examinations are considered. The value of DMSA renograms in predicting recovery in obstructive uropathy and in deciding to opt for conservative therapy or nephrectomy is discussed.

Topics: Aged; Child; Follow-Up Studies; Humans; Kidney; Kidney Calculi; Kidney Diseases; Nephrectomy; Postoperative Period; Preoperative Care; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Ureteral Obstruction

A new technique for experimental reversible hydronephrosis in the rat was developed. A noninvasive radioisotopic investigation, using Tc-99m dimercaptosuccinic acid, permitted sequential assessment of the separate renal function at different stages of the study. After 1 week of unilateral ureteral obstruction, reversibility was obtained by the removal of the obstructive device. Ten days after the obstruction release, the ipsilateral kidney had returned to 71 per cent of its preligation uptake value. Histological findings demonstrated the reversibility of the surgical obstruction.

Topics: Animals; Constriction; Disease Models, Animal; Hydronephrosis; Kidney; Male; Methods; Radionuclide Imaging; Rats; Rats, Inbred Lew; Succimer; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Ureter; Ureteral Obstruction

The evolution of the 99mTc-dimercaptosuccinic acid (DMSA) renal uptake is followed after ligation of the right ureter in rats. The DMSA uptake falls rapidly from 35% before ligation to 13% after 24 h, and decreases further to 1.5% after 31 days. The ligated ureter was desobstructed after 10, 17, 24 and 31 days, respectively, DMSA uptake was controlled 4, 11 and 18 days after desobstruction. In the first group, deobstruction after 10 days, the DMSA uptake rose from 7 to 15%, while in the fourth group it rose from 1.5 to 2%. It is concluded that DMSA uptake provides a reliable index for renal function after acute urinary tract obstruction in rats. If the DMSA uptake has fallen below 4% very little renal function can be expected to be regained, whereas above 4% the function can improve considerably.

Topics: Acute Disease; Animals; Kidney; Kidney Function Tests; Male; Rats; Rats, Inbred Strains; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Time Factors; Ureteral Obstruction

To establish a method of detecting divided renal function of the obstructed kidneys noninvasively, comparative studies on 99mTc -DMSA uptake (60 minutes after injection), I 131-hippuran renal uptake (1-2 minutes after injection) and divided creatinine clearance immediately after relief of urinary obstruction were made on 24 cases of obstructive uropathy. A close significant correlation was obtained between 99mTc -DMSA and I 131-hippuran renal uptakes (gamma = 0.8809, P less than 0.001). Also, a significant correlation was noted between 99mTc -DMSA renal uptake and divided creatinine clearance (gamma = 0.7876, P less than 0.001), but the latter constantly gave lower values than the former. These observations led us to conclude that 99mTc -DMSA renal uptake is a reliable indicator of the renal plasma flow in the obstructed kidneys. Quantitative divided renal function of the obstructed kidneys can be estimated by the 99mTc -DMSA uptake method.

Topics: Adolescent; Adult; Child; Creatinine; Female; Humans; Kidney; Male; Middle Aged; Radionuclide Imaging; Renal Circulation; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Ureteral Obstruction

We studied 17 hydronephrotic kidneys owing to stenosis of the pyeloureteral junction. Preoperative uptake of 99mtechnetium dimercaptosuccinic acid was compared to early postoperative unilateral creatinine clearance, measured by urine collection from the nephrostomy tube. An excellent correlation was found. Therefore, uptake of 99mtechnetium dimercaptosuccinic acid represents a reliable parameter of renal function even in the presence of severe urinary tract obstruction. However, 99mtechnetium dimercaptosuccinic acid uptake should be measured more than 24 hours after injection of the tracer.

Topics: Adolescent; Adult; Creatinine; Female; Humans; Hydronephrosis; Infant; Kidney; Male; Postoperative Care; Preoperative Care; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Ureteral Obstruction

Major advances in nuclear medicine instrumentation and radiopharmaceuticals for renal studies have occurred during the last decade. Current nuclear medicine methodology can be applied for accurate evaluation of renal function and for renal imaging in a wide variety of clinical situations. Total renal function can be estimated from the plasma clearance of agents excreted by glomerular filtration or tubular secretion, and individual function can be estimated by imaging combined with renography. A major area of radionuclide application is in the evaluation of obstructive uropathy. The introduction of diuretic renography and the use of computer-generated regions of interest offer the clinician added useful data which may aid in diagnosis and management. Imaging is of proven value also in trauma, renovascular hypertension, and acute and chronic renal failure. Methods for the evaluation of residual urine, vesicoureteral reflux, and testicular torsion have achieved increasing clinical use. These many procedures assure a meaningful and useful role for the application of nuclear medicine in genitourinary imaging.

Topics: Adult; Female; Humans; Infant; Iodohippuric Acid; Kidney Failure, Chronic; Male; Middle Aged; Organotechnetium Compounds; Pentetic Acid; Radioisotope Renography; Spermatic Cord Torsion; Succimer; Sugar Acids; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Ureteral Obstruction; Urinary Tract Infections; Urologic Diseases; Vesico-Ureteral Reflux

Renal uptake of 99m Tc DMSA was used to evaluate the renal function of 16 healthy subjects (controls) and 115 patients with various urinary tract diseases. Scintigraphic examination was carried out 6 hours after an intravenous injection of the product. In the 16 controls Tc DMSA uptake was 25.7 +/- 2.48% in the right kidney and 24.4 +/- 2.86% in the left kidney. In 36 patients with one single hypertrophied kidney, there was a correlation (r = 0.850) between creatinine clearance and Tc DMSA uptake, which was higher than in normal subjects (39.23 +/- 9.9%). In the group of 68 patients with unilateral (31) or bilateral (37) renal disease, a significant correlation (r = 0,725) was observed between kidney-to-kidney ratios of urea clearance and Tc DMSA uptake, so that renal impairment could be quantified. Quantitative scintigraphy did not appear to be of assistance in the remaining 11 patients with obstructive uropathy, as it overestimated renal function. The results obtained with 99 m Tc DMSA scintigraphy should be helpful in choosing between nephrectomy and conservative surgery and in assessing the degree of compensatory hypertrophy in single kidneys.

Topics: Creatinine; Humans; Kidney; Kidney Diseases; Nephrectomy; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Ureteral Obstruction

Topics: Female; Humans; Kidney; Male; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Ureteral Obstruction; Urologic Diseases

In 35 patients, renography with 131I-o-hippurate (OIH) and static renal imaging with 99mTc-dimercaptosuccinic acid (DMSA) were used to measure differential renal function (DRF). The results were compared. Depth correction was applied in both methods. In non-obstructed kidneys (19 patients), both methods revealed nearly identical kidney function (r = 0.98). For completely obstructed kidneys (16 patients), OIH gave a significantly better DRF (14 ml/min) than DMSA. This small difference was of no clinical value. Because DMSA is reported to give unreliable results in unilateral obstructed kidneys, the right ureter was ligated in 8 dogs for 10 days and DRF was measured before and after opening an ureteral fistula. The difference in DRF was about 1% and could be accounted for by the amount of urinary radioactivity collected from the pelvic system after the ligature had been opened. Although DMSA appears to give reliable values in determining DRF, even in obstructed kidneys, OIH is preferred since total clearance values and postrenal urinary dynamics can be determined simultaneously.

Topics: Animals; Dogs; Fistula; Humans; Iodohippuric Acid; Kidney; Kidney Diseases; Metabolic Clearance Rate; Radioisotope Renography; Succimer; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Ureteral Obstruction

The catheter-free determination of the unilateral 131I-hippuran clearance correlates well with the unilateral clearance determination with 99mTc-DMSA in patients without obstruction. In patients with unilateral chronic obstruction the clearance of 131I-hippuran on the average is 13% higher than the clearance determined by the DMSA method. After successful correction of the obstruction the two values are identical. 123I-hippuran is foundin the renal pelvis already after 90 seconds in some cases of marked chronic obstruction. The functioning part of the involved kidney is therefore possibly overestimated whereas the DMSA uptake reflects the actual function. Both radioisotope methods should be applied preoperatively in order to evaluate the individual renal function. Functional scintigraphy in patients with obstruction should preferably be carried out with 123I-hippuran.

Topics: Humans; Iodohippuric Acid; Radioisotope Renography; Succimer; Technetium; Ureteral Obstruction

43 patients underwent an extended scintigraphic procedure with 99mTc-dimercaptosuccinylic acid in order to investigate its proper use for diagnosing morphological and functional kidney abnormalities. The group was comprised of patients without renal disease, and patients with diffuse parenchymal disease, obstructive uropathy, renal cysts and renal tumors. The study was followed by 131I-hippurate renography. We propose a simplified routine procedure with scintiphotos taken 10-15 min after injection for topographic information and 120 min after injection for renal morphology. This procedure allows excellent case finding of diffuse parenchymal disease of a special value in cases of radiological non-visualization. The technique is indicated, when iodine contrast media cannot be used for radiological examinations. DMSA studies, however, do not allow safe functional evaluation in all categories of patients. Neither can obstructive nephropathy be diagnosed unless the renal pelvis is dilated. Renal perfusion studies are contaminated by the perfusion of liver and spleen. Nevertheless, a tentative differentiation between cysts and tumours is possible, the former being hypoperfused the latter hyperperfused. When supplemented with gamma camera 131I-hippurate renography, the total scintigraphic procedure will also include split function determination and run-off evaluation.

Topics: Humans; Iodine Radioisotopes; Iodohippuric Acid; Kidney; Kidney Diseases; Kidney Diseases, Cystic; Kidney Neoplasms; Pyelonephritis; Radioisotope Renography; Succimer; Sulfhydryl Compounds; Technetium; Ureteral Obstruction