technetium-tc-99m-exametazime and Kidney-Failure--Chronic

We used technetium-99m hexamethylpropylene amine oxime (Tc-99m HMPAO) lung scan to detect subclinical lung injury in patients with chronic renal failure (CRF), on regular hemodialysis (HD), who had normal chest X-ray findings (CXR) and pulmonary function test (PFT). The degree of pulmonary vascular endothelium damage was represented as lung/liver uptake ratios (L/L ratios) calculated by Tc-99m HMPAO lung scan. The L/L ratios of the 20 male CRF patients on HD with normal CXR and PFT were compared with those of the 20 male normal controls. The results show that the L/L ratios on Tc-99m HMPAO lung scans were significantly higher in CRF patients on HD (1.06 +/- 0.55) than those in normal controls (0.34 +/- 0.09). Using a cut-off value of 0.50, 18/20 [90%] CRF patients had abnormally increased L/L ratios. Our findings concluded that the pulmonary vascular endothelium damage represented as significantly increased L/L ratios on Tc-99m HMPAO lung scan in CRF patients on HD with normal CXR and PFT. In addition, Tc-99m HMPAO lung scan has the potential to be a sensitive, objective and noninvasive method to detect subclinical lung injury of CRF patients on HD, which is different from the traditional studies such as CXR or PFT.

Topics: Adult; Aged; Case-Control Studies; Humans; Kidney Failure, Chronic; Lung; Lung Diseases; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Renal Dialysis; Technetium Tc 99m Exametazime

Patients undergoing long-term renal replacement therapy (such as dialysis) have an increased risk for significant cognitive impairment, which may result in memory problems and subsequently missed attendance at dialysis. The aim of this study was to try to identify any abnormalities of cerebral perfusion that could explain a patient's cognitive impairment and to determine if the pattern of these abnormalities would suggest a cause.. 17 patients (13 men; mean age, 60 years; age range, 29-74 years) in end-stage renal failure or on dialysis had SPECT imaging 10 minutes after injection of 550 MBq (15 mCi) Tc-99m HMPAO. Two of the patients had a history of previous stroke. Other risk factors for stroke were noted in most of the patients (hypertension in 10 patients, smoking or former smoking in 10 patients, and cardiac atherosclerosis in 7 patients). In all patients, attenuation correction was applied and the images were reconstructed into three sets of orthogonal slices. Activity in the frontal and temporal lobes was compared by quantification against the ipsilateral and contralateral cerebellum.. Discrete cortical defects consistent with infarcts were seen in 14 patients. The mean right and left frontal-to-cerebellar ratio was 0.837 (SD, 0.09) and 0.837 (SD, 0.08), respectively. This was not significantly different from the right and left temporal-to-cerebellar ratios of 0.843 (SD, 0.07) and 0.848 (SD, 0.07), respectively. Both were within normally accepted ranges.. Patients in end-stage renal failure who also had cognitive impairment appear to have a high number of cortical defects consistent with infarcts (suggesting a multiple-infarct type of dementia). There was no evidence of Alzheimer-type dementia.

Topics: Adult; Aged; Brain; Cerebrovascular Circulation; Cognition Disorders; Dementia, Multi-Infarct; Female; Humans; Kidney Failure, Chronic; Male; Middle Aged; Prospective Studies; Renal Replacement Therapy; Risk Factors; Stroke; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

We studied 20 patients aged 46-69 years (mean 57 years) undergoing long-term haemodialysis (HD) and 20 age- and sex-matched controls with single photon emission tomography (SPET) and 99Tcm-hexamethyl-propyleneamine-oxime to look for regional abnormalities in cerebral blood flow (CBF) and their relation to cognitive dysfunction. Global hemispheric tracer uptake relative to the cerebellum was similar in both groups, but regional over cerebellar activity was significantly reduced in the frontal cortex (85.9 +/- 5.1 vs 90.4 +/- 5.3; P = 0.01) and thalamus (99.2 +/- 8.8 vs 104.9 +/- 8.4; P = 0.05) of the HD patients. Normalization to whole-brain activity also showed the frontal cortex to be hypoactive in the HD patients, while tracer uptake was increased occipitally. These regional differences were not explained by the presence of atrophy or cerebrovascular damage seen on brain magnetic resonance imaging. The HD patients scored significantly worse on cognitive tests such as the Mini Mental State Examination (23 +/- 4 vs 28 +/- 1; P < 0.001) and Mattis Dementia Rating Scale (114 +/- 24 vs 143 +/- 1; P < 0.001). Regional activity ratios did not correlate with cognitive test scores, however. Our results indicate a disturbed pattern of CBF in HD patients, although regional SPET abnormalities did not correspond to the severity of cognitive dysfunction.

Topics: Aged; Case-Control Studies; Cerebrovascular Circulation; Cognition; Cognition Disorders; Female; Humans; Kidney Failure, Chronic; Male; Middle Aged; Organotechnetium Compounds; Oximes; Renal Dialysis; Technetium Tc 99m Exametazime; Tomography, Emission-Computed, Single-Photon

Topics: Abdomen; Abscess; Female; Humans; Kidney Failure, Chronic; Leukocytes; Middle Aged; Organotechnetium Compounds; Oximes; Peritoneal Dialysis, Continuous Ambulatory; Peritoneal Diseases; Peritonitis; Radionuclide Imaging; Technetium Tc 99m Exametazime