technetium-tc-99m-gluceptate and Acute-Kidney-Injury

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

Sixteen infants, 2 to 35 days of age, had acute renal failure, a diagnosis based on serum creatinine concentrations greater than 1.5 mg/dL for at least 24 hours. Eight infants were oliguric (urine flow less than 1.0 mL/kg/h) whereas the remainder were nonoliguric. To determine clinical parameters useful in prognosis, urine flow rate, duration of anuria, peak serum creatinine, urea (BUN) concentration, and nuclide uptake by scintigraphy were correlated with recovery. Nine infants had acute renal failure secondary to perinatal asphyxia, three had acute renal failure as a result of congenital cardiovascular disease, and four had major renal anomalies. Four oliguric patients died: three of renal failure and one of heart failure. All nonoliguric infants survived with mean follow-up serum creatinine concentration of 0.8 +/- 0.5 (SD) mg/dL whereas that of oliguric survivors was 0.6 +/- 0.3 mg/dL. Peak serum creatinine concentration did not differ between those patients who were dying and those recovering. All infants who were dying remained anuric at least four days and revealed no renal uptake of nuclide. Eleven survivors were anuric three days or less, and renal perfusion was detectable by scintigraphy in each case. However, the remaining survivor (with bilateral renal vein thrombosis) recovered after 15 days of anuria despite nonvisualization of kidneys by scintigraphy. In neonates with ischemic acute renal failure, lack of oliguria and the presence of identifiable renal uptake of nuclide suggest a favorable prognosis.

Topics: Acute Kidney Injury; Asphyxia Neonatorum; Blood Urea Nitrogen; Creatinine; Glomerular Filtration Rate; Heart Failure; Humans; Infant; Infant, Newborn; Iodohippuric Acid; Ischemia; Kidney; Organotechnetium Compounds; Prognosis; Radionuclide Imaging; Retrospective Studies; Sugar Acids; Technetium; Time Factors

Topics: Acute Kidney Injury; Aged; Humans; Kidney; Male; Organotechnetium Compounds; Radionuclide Imaging; Sugar Acids; Technetium