technetium-tc-99m-gluceptate and Hypertension--Renovascular

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

The aim of this study was to define the use of the triple radiopharmaceutical renal study (TRRS) for renal scintigraphy as a physiological tool for renal evaluation, and to determine if the sensitivity and/or specificity of a renal study for the diagnosis of renovascular hypertension (RVH) could be improved by the combination of three radiopharmaceuticals (i.e., I-131 OIH, Tc-99m DTPA, and Tc-99m glucoheptonate). One hundred ninety-five patients with suspected RVH underwent TRRS, standard Tc-99m DTPA renal studies, and renal angiography. One hundred eighty-nine patients were hypertensive and ischemic nephropathy was suspected in six. Ninety-one, including three patients with ischemic nephropathy, had a renal artery stenosis of 70% or more (66 unilateral, 25 bilateral). Effective renal plasma flow (ERPF), glomerular filtration rate (GFR) (from plasma clearance of I-131 OIH and Tc-99m DTPA), and geometric renal masses (from Tc-99m glucoheptonate study) were compared to normal values corrected for body surface, to determine the severity of renal dysfunction. For the TRSS, RVH criteria included: 1) differential Tc-99m DTPA function minus differential Tc-99m glucoheptonate function of affected kidney ( < -5% or > 5%) and 2) functional parameters: ERPF = 1.6-2.0 ml/g/minute, GFR = 0.25-0.4 ml/g/minute, and filtration fraction (i.e., GFR/ERPF = 0.15-0.20) on the affected side.

Topics: Aged; Female; Glomerular Filtration Rate; Humans; Hypertension, Renovascular; Iodine Radioisotopes; Iodohippuric Acid; Male; Middle Aged; Organotechnetium Compounds; Predictive Value of Tests; Prevalence; Radiography; Radioisotope Renography; Renal Artery; Renal Plasma Flow, Effective; Retrospective Studies; Sensitivity and Specificity; Sugar Acids; Technetium Tc 99m Pentetate

This study attempted to evaluate the role of glucoheptonate (GHA) in captopril renography in an in vivo laboratory investigation in which postcaptopril glucoheptonate uptake was analysed in awake 2KlC hypertensive rats. Clamped kidney uptake in a previous study was greater in the poststenotic kidney than in the normal kidney (P = 0.01) in rats with mild renal artery stenosis. A glucoheptonate renogram protocol was developed for use in rats anaesthetized with sodium pentobarbital. An 123I-hippuran scan was performed to determine the relative renal function, followed by a control 99Tcm-GHA scan. Five minutes after administering captopril, another 99Tcm-GHA scan was performed. Relative renal uptake was determined between 30 and 90 s postinjection. 99Tcm-GHA uptake in the clamped kidney was more than 50% of total uptake in 3/9 of the abnormal rats' control scans. No abnormal rats clamped kidney 99Tcm-GHA uptake was greater than 50% in the postcaptopril scans. Captopril reduced GHA uptake in all nine of the animals with baseline scans. These findings suggest that the laboratory observation of captopril induced paradoxically increased 99Tcm-GHA uptake in renal artery stenosis may not be observed scintirenographically. Moreover, the data support a potential value of glucoheptonate in captopril renography.

Topics: Animals; Captopril; Hypertension, Renovascular; Iodohippuric Acid; Male; Organotechnetium Compounds; Radioisotope Renography; Rats; Rats, Sprague-Dawley; Renal Artery Obstruction; Sugar Acids

Topics: Animals; Captopril; Creatinine; Hypertension, Renovascular; Male; Organotechnetium Compounds; Rats; Rats, Inbred Strains; Renal Circulation; Sugar Acids

Topics: Adult; Humans; Hypertension, Renovascular; Male; Organotechnetium Compounds; Radioisotope Renography; Sugar Acids; Technetium; Time Factors

Radionuclide renal studies are particularly well suited to pediatrics as renal problems in children usually are part of a dynamic process which requires serial assessment. The absence of side-effects and the low radiation dose has added to their popularity in pediatrics. A number of different renal parameters can be evaluated using the appropriate radiopharmaceutical and method of analysis. The renal study is of value to assess patients with hydronephrosis both pre-operatively and for serial follow-up post-operatively, as well as to distinguish obstructive from non-obstructive uropathy. Perfusion to the kidney may be assessed and ischemic areas detected in children with hypertension or trauma. The renal scan commonly is used in patients with congenital anomalies such as ectopic and duplex kidneys, nonvisualized kidney on IVP and in children with oliguria or anuria secondary to diseases such as acute tubular necrosis, hemolytic uremic syndrome, and renal vein thrombosis. It frequently is done as an emergency procedure in neonates. In conjunction with the IVP and ultrasound, the renal study is useful in some cases of abdominal mass to distinguish between hydronephrosis, cystic kidneys and tumors.

Topics: Adolescent; Child; Child, Preschool; Female; Glomerular Filtration Rate; Humans; Hydronephrosis; Hypertension, Renovascular; Infant; Infant, Newborn; Kidney; Kidney Function Tests; Kidney Tubular Necrosis, Acute; Male; Organotechnetium Compounds; Pentetic Acid; Radioisotopes; Radionuclide Imaging; Sugar Acids; Technetium; Technetium Tc 99m Pentetate; Ureteral Obstruction; Urinary Bladder