technetium-tc-99m-gluceptate and Kidney-Diseases

Noninvasive radionuclide procedures in the evaluation of renal disease have been accepted increasingly as effective and valuable alternatives to older clinical methods. The development of suitable radiopharmaceuticals labeled with high photon intensity radionuclides and with 99mTc in particular has stimulated this modality during the last few years. Currently several nearly ideal agents are available for anatomical and functional studies of kidney imparting very low absorbed radiation doses. These include 99mTc-GHA and 99mTc-DMSA for renal morphology and differential function evaluation, 99mTc-DTPA for GFR and 123I orthoiodohippurate for ERPF measurements. A suitable agent as a replacement for the latter labeled with 99mTc is actively being sought. Computer-assisted processing of dynamic renal function studies enables the observer to obtain a wealth of information related to the renal extraction, uptake, parenchymal transit and pelvic transit parameters of the agent administered into the bloodstream. Each of these parameters either globally or differentially contributes to a detailed evaluation of renal disease states. Several of these procedures have been validated against classical techniques clinically but more detailed information is being sought with the recently introduced radiopharmaceuticals. With the detailed validation and increasing recognition of the clinical utility of several of the radionuclidic procedures at many centers, it is hoped that radionuclide assessment of renal disorders ultimately will be made available routinely at all medical facilities.

Topics: Carbon Radioisotopes; Chlormerodrin; Chromium Radioisotopes; Diatrizoate; Glomerular Filtration Rate; Humans; Inulin; Iodine Radioisotopes; Iodohippuric Acid; Iothalamic Acid; Kidney Diseases; Mercury Radioisotopes; Organotechnetium Compounds; Pentetic Acid; Radiation Dosage; Radioisotopes; Radionuclide Imaging; Renal Circulation; Succimer; Sugar Acids; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Vitamin B 12

Topics: Hippurates; Humans; Iodine Radioisotopes; Kidney; Kidney Diseases; Kidney Function Tests; Organotechnetium Compounds; Pentetic Acid; Radionuclide Imaging; Renal Circulation; Succimer; Sugar Acids; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate

A 40-year-old man was examined because he was a potential "healthy" renal donor. However, the routine work-up before surgery revealed hypertension, although there was no family history of this condition. The patient was examined to exclude secondary causes of hypertension. Tc-99m glucoheptonate renal imaging showed nephroptosis of the right kidney when the patient was standing, and this may have been the cause of the hypertension.

Topics: Adult; Humans; Hypertension; Kidney Diseases; Male; Organotechnetium Compounds; Posture; Prolapse; Radionuclide Imaging; Radiopharmaceuticals; Sugar Acids; Supine Position

The scintigraphic findings in a rare case of bilateral renal malakoplakia are presented. Markedly increased Ga-67 activity was present in both kidneys in sites corresponding to focal cortical defects on Tc-99m gluceptate (glucoheptonate) imaging. Interestingly, there was no abnormal renal activity with In-111 leukocyte scanning.

Topics: Female; Gallium Radioisotopes; Humans; Indium Radioisotopes; Kidney Diseases; Leukocytes; Malacoplakia; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sugar Acids

Differential renal blood flow and parenchymal mass were compared in 50 pairs of scintigraphic studies performed on 44 patients. Background corrected total kidney counts were determined between 1 to 2 minutes following injection of I-123 or I-131 orthoiodohippurate (OIH), and at 1 to 2.5 hours after injection of Tc-99m glucoheptonate (GHA). The OIH and GHA differentials agreed within 5% in 36 studies (72%). When the OIH differentials were symmetric (45% to 55% in each kidney), agreement with the GHA results was complete (17 out of 17). By comparison, 42% (14 out of 33) of studies with asymmetric OIH differentials had a greater than 5% disparity from the GHA split function. Serum creatinine was elevated at the time of 9 out of 14 studies (64%) with OIH/GHA disagreement and 18 out of 36 studies (50%) with OIH/GHA agreement. Of the 14 studies with disparate OIH/GHA differentials, the GHA differential was more symmetric in 10 (71%). When different scinitigraphic measures of differential renal flow and parenchymal mass disagree, this is most likely due to the effects of asymmetric renal impairment rather than to those of global renal dysfunction.

Topics: Creatinine; Humans; Iodine Radioisotopes; Iodohippuric Acid; Kidney Diseases; Organotechnetium Compounds; Radioisotope Renography; Renal Circulation; Sugar Acids; Ureteral Obstruction

The efficacy of different radiodiagnostic agents for demonstrating the decline in renal function from cyclosporine (CyA) nephrotoxicity was assessed in rats receiving a standard dose of the drug for 2 wk, compared with control rats. The agents included [99mTc]DTPA, [131I]hippuran, [111In]lysozyme, [99mTc]glucoheptonate (GHA), [99mTc]dimercaptosuccinate (DMS) and [111In]aminated dextran (amdex). A small dose of [99mTc]- or [111In]DTPA was administered simultaneously to normalize the results for variations in drug response from one animal to another. There were statistically significant differences in the detectability of the renal functional impairment by plasma clearance, early and 2-hr renal uptake among the different agents. However, none was clearly superior to DTPA. This conclusion is consistent with previous studies which showed a parallel decline in glomerular filtration rate (GFR) and effective renal plasma flow in acute CyA toxicity probably due primarily to vasoconstriction.

Topics: Animals; Cyclosporins; Indium Radioisotopes; Iodine Radioisotopes; Iodohippuric Acid; Kidney; Kidney Diseases; Male; Organometallic Compounds; Organotechnetium Compounds; Pentetic Acid; Radionuclide Imaging; Rats; Rats, Inbred Strains; Succimer; Sugar Acids; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Tissue Distribution

Topics: Child; Humans; Kidney Diseases; Organometallic Compounds; Organotechnetium Compounds; Radionuclide Imaging; Succimer; Sugar Acids; Sulfhydryl Compounds; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid

Infection is the most common disease of the urinary tract in children, and various imaging techniques have been used to verify its presence and location. On retrospective analysis, 50 consecutive children with documented upper urinary tract infection had abnormal findings on renal cortical scintigraphy with 99mTc-glucoheptonate. The infection involved the renal poles only in 38 and the poles plus other renal cortical areas in eight. Four had abnormalities that spared the poles. Renal sonograms were abnormal in 32 of 50 children. Excretory urograms were abnormal in six of 23 children in whom they were obtained. Vesicoureteral reflux was found in 34 of 40 children in whom voiding cystourethrography was performed. These data show the high sensitivity of renal cortical scintigraphy with 99mTc-glucoheptonate in documenting upper urinary tract infection. The location of the abnormalities detected suggests that renal infections spread via an ascending mode and implies that intrarenal reflux is a major contributing factor.

Topics: Acute Disease; Adolescent; Child; Child, Preschool; Female; Humans; Infant; Kidney Diseases; Male; Organotechnetium Compounds; Radionuclide Imaging; Retrospective Studies; Sugar Acids; Technetium; Tomography, X-Ray Computed; Ultrasonography; Urinary Tract Infections; Urography; Vesico-Ureteral Reflux

Differential renal function was calculated by using 99mTc-glucoheptonate (Tc-GH) in 51 patients. Computer-acquired background-corrected individual renal function was calculated by using both the 1-3-min uptake counts and the 2-4-hr delayed static counts. The degree of correlation between the two was high (r = .96). An equally high correlation was noted in 16 children who were 12 years old or younger, in 15 patients with renal size disparity greater than 60/40%, and in six patients with abnormal creatinine clearances. Ten patients had a 30-min dynamic 99mTc-DTPA study followed immediately by the injection of Tc-GH and acquisition of delayed static images 2-4 hr later. A high degree of correlation (r = .99) was seen between the 1-3-min differential function obtained by using Tc-DTPA and the 2-4-hr delayed differential function obtained by using Tc-GH. This study shows that Tc-GH is a clinically useful and valid tool for calculation of differential renal function and that Tc-GH combines many of the best aspects of Tc-DTPA and Tc-DMSA.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Evaluation Studies as Topic; Humans; Image Processing, Computer-Assisted; Infant; Kidney Diseases; Middle Aged; Organometallic Compounds; Organotechnetium Compounds; Pentetic Acid; Radioisotope Renography; Sugar Acids; Technetium; Technetium Tc 99m Pentetate; Time Factors

Topics: Diagnosis, Differential; Humans; Iodohippuric Acid; Kidney; Kidney Diseases; Nephrology; Nuclear Medicine; Organotechnetium Compounds; Pentetic Acid; Radionuclide Imaging; Succimer; Sugar Acids; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Urology

Eighteen patients with gastrointestinal and retroperitoneal non-Hodgkin's lymphoma received abdominal radiotherapy as their primary treatment. Each patient received a total tumor dose of 2200 to 4500 cGy in 5 to 9 weeks to the whole or half of one kidney. Nine patients developed unilateral radiation nephropathy demonstrable on post-treatment evaluation with 99m Tc glucoheptonate blood flow, delayed static scan, and an I-131 radio-hippurate renal perfusion study. The tests were periodically repeated over periods ranging from 5 to 8 years. Six patients with nephropathy and 4 patients without nephropathy were followed 5 years or longer. The minimum nephro-pathogenic irradiation dose was 2200 cGy delivered in 59 days. The incidence of nephropathy is higher with increase in the total dose. Short term recovery in function was observed in 3 patients and long-term complete recovery was observed in one patient. Atrophic renal change was irreversible and progressive in 3 patients over a 6 to 7 year follow-up period. In this group of patients, an abnormal creatinine clearance and serum beta-2 microglobulin level was indicative of vascular damage. Elevated arterial blood pressure was seen in 5 patients. All were controlled medically, without nephrectomy. There was no other clinically significant problem resulting from the unilateral nephropathy in this group of patients.

Topics: Follow-Up Studies; Gastrointestinal Neoplasms; Humans; Iodohippuric Acid; Kidney; Kidney Diseases; Lymphoma; Organotechnetium Compounds; Radionuclide Imaging; Radiotherapy, High-Energy; Retroperitoneal Neoplasms; Sugar Acids; Technetium

Topics: Adult; Cysts; Female; Humans; Kidney; Kidney Diseases; Kidney Transplantation; Organotechnetium Compounds; Radionuclide Imaging; Sugar Acids; Technetium; Urinary Bladder

We compared technetium Tc 99m glucoheptonate renal scan with standard renal arteriography in 22 patients with various renal abnormalities. The diagnostic accuracy and degree of image resolution indicates this study is a useful and safe clinical addition to the diagnostic armamentarium.

Topics: Humans; Kidney; Kidney Diseases; Kidney Neoplasms; Organotechnetium Compounds; Radiography; Radionuclide Imaging; Renal Artery; Renal Artery Obstruction; Sugar Acids

Topics: Humans; Kidney Diseases; Organotechnetium Compounds; Radiography; Radionuclide Imaging; Sugar Acids; Technetium

Gluceptate renal imaging was performed to evaluate renal function and morphology in 50 pediatric patients (27 males, 23 females). Retrospective categorization revealed that 49% (27) of the studies were for functional evaluation, 27% (15) were for anatomic considerations and 23% (13) were of a miscellaneous nature. Thirty-one patients also underwent intravenous pyelograms (IVP) and in seven discordant cases gluceptate imaging provided correct information in five, compared with only one correct IVP. While both the IVP and gluceptate imaging provide clinical information concerning renal function and morphology, the ability to obtain blood flow data and to quantitate differential renal functional mass allows gluceptate imaging to define renal function more specifically than the IVP making a more meaningful diagnostic procedure for the evaluation of patients with known or suspected renal abnormalities.

Topics: Adolescent; Adult; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Kidney; Kidney Diseases; Male; Organotechnetium Compounds; Radionuclide Imaging; Sugar Acids; Technetium; Urography

In 50 patients with obstructive uropathy, nuclear imaging supplementary to excretory urography did not improve the detection of obstruction or the determination of the site or etiology of the lesion. However, rapid sequential radionuclide images showed decreased renal perfusion in 64%, more frequently than did an obstructive nephrogram (40%); this finding appeared to occur with more severe degrees of obstruction. Functional impairment of the obstructed kidney was demonstrated more often with 131I Hippuran (o-iodohippurate sodium) (91%) than with 99mTc glucoheptonate (68%) or excretory urography (66%). Neither nuclear nor urographic studies could predict the degree of functional recovery of the kidney until the increased intrapelvic pressures was relieved.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Contrast Media; Female; Humans; Infant; Iodohippuric Acid; Kidney Diseases; Male; Middle Aged; Nephrons; Organotechnetium Compounds; Radionuclide Imaging; Retrospective Studies; Sugar Acids; Time Factors; Ureteral Obstruction; Urography

Tc-99m gluceptate renal imaging was compared with the intravenous urogram in 41 patients. While the specificity of the examination was essentially the same for both techniques, the sensitivity for the detection of renal mass lesions was better with gluceptate imaging. The study suggests the desirability of a shift in emphasis from the IVU to the Tc-99m gluceptate scintigram in the early evaluation of suspected renal mass lesions, and merits further clinical evaluation.

Topics: Adolescent; Adult; Aged; Angiography; Child; Child, Preschool; Diatrizoate Meglumine; Humans; Image Enhancement; Infant; Kidney Cortex; Kidney Diseases; Kidney Neoplasms; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Sugar Acids; Technetium; Urography