renal scintigraphy prepared and presented by paul jolles, md
TRANSCRIPT
RENAL SCINTIGRAPHY
Prepared and Presented byPaul Jolles, MD
Kidney Stone
Anatomy Kidneys to Urinary
Bladder
ureterolithiasis
INDICATIONS
• DIFFERENTIAL FUNCTION• GFR, ERPF• OBSTRUCTION• POST OPERATIVE EVALUATION• NEED FOR FREQUENT FOLLOW-UP• AZOTEMIA• CONTRAST ALLERGY
HISTORICAL BACKGROUND
CONTRAST UROGRAPHY FIRST CLINICALLY USEFUL
UROGRAM 1929: DR. MOSES SWICK (U.S.)
IVP Phase IInitial injectionDynamic
IVP Phase IICortical Transit
IVP Phase IIIExcretory
IVP Phase IIIExcretory
IVP Phase IIIExcretory
HISTORCAL BACKGROUND
1945: I-131 PRODUCTION (U.S.)1947: COLTMAN AND MARSHALL
(U.S.) KOLLMAN (GERMANY) SCINTLLATION COUNTER
(PMT)
HISTORICAL BACKGROUND
1952: OESSER , BILLION (GER) COLLECTED URINE 1955: TAPLIN, WINTER (U.S.) FIRST RENOGRAM 1957: ANGER CAMERA (U.S.)
Renal Agents •Contrast •PAH•HIPP•Others
RADIOPHARMACEUTICALS
• TUBULAR SECRETION• GLOMERULAR FILTRATION• CORTICAL BINDING• MIXED
TUBULAR SECRETION
EFFECTIVE RENAL PLASMA FLOW
I-131 ORTHIODOHIPPURATETc-99m MERCAPTOACEYTL-
TRIGLYCINE (MAG3)
I-131 HIPPURAN
20% FILTERED80% SECRETEDDOSE: 300 uCi
Tc-99m MAG3
TUBULAR SECRETION 90% FILTRATION 10% DOSE: 5-10 mCi
Tc-99m MAG3 IMAGING
FLOW (ARTERIAL) UPTAKE (NEPHROGRAM) EXCRETION (“CORTICAL
TRANSIT”)
GLOMERULAR FILTRATION
GLOMERULAR FILTRATION RATE
Tc-99m DIETHYLENETRIAMINEPENTAACETIC ACID (DTPA)
IODINATED CONTRASTGd-DTPA
Tc-99m DTPA
GLOMERULAR FILTRATIONMETAL CHELATOR
20% EXTRACTION FRACTIONDOSE: 5-20 mCi
Tc-99m DTPA IMAGING
FLOW (ARTERIAL) UPTAKE (NEPHROGRAM) EXCRETION (“CORTICAL TRANSIT”)
RENOVASCULAR HYPERTENSION
ABRUPT ONSET HTN <30>55 YRS SEVERE/MALIGNANT HTN
REFRACTORY HTN
RENOVASCULAR HYPERTENSION
EPIGASTRIC BRUITMOD HTN WITH VASCULAR DZACE INHIBITOR-INDUCED RF
RENOVASCULAR HYPERTENSION
<1% HYPERTENSIVE PATIENTSATHEROSCLEROSIS FIBROMUSCULAR DYSPLASIARAS NOT NECESSARILY RVH
CAPTOPRIL RENOGRAPHY
MEDICATION HISTORYDISCONTINUE ACE
INHIBITORSSERUM CHEMISTRY (BUN/Cr)
CAPTOPRIL RENOGRAPHY
ORAL AND IV HYDRATIONBP MONITORING
25 MG CAPTOPRIL ORALLY10 mCi MAG 3 AND LASIX
CAPTOPRIL RENOGRAPHY
PHYSIOLOGY OF RVHDIMINISHED RBF
RENIN-ANGIOTENSINEFFERENT ARTERIOLE
CAPTOPRIL RENOGRAPHY
PROLONGED TIME TO PEAKCORTICAL RETENTION >30%
BASELINE STUDY
LASIX RENOGRAPHY
EVALUATION FOR OBSTRUCTION
LASIX WASHOUT HALF TIME
LASIX WASHOUT T1/2
TIME FOR CLEARANCE OF ½ ACTIVITY FROM THE KIDNEY
AFTER LASIX
LASIX WASHOUT T1/2
NORMAL: <10-15 MINOBSTRUCTED: >20 MIN
DILATED, NON-OBSTRUCTED
• PROGRESSIVE PELVOCALEAL TRACER ACCUMULATION
• PROMPT LASIX WASHOUT
DILATED, OBSTRUCTED
• PROGRESSIVE PELVOCALYCEAL TRACER ACCUMULATION
• IMPAIRED LASIX WASHOUT
IMPAIRED FUNCTION
RENAL FAILURE S/P AAA REPAIRTc-99m MAG3
• FLOW• UPTAKE• CORTICAL TRANSIT• EXCRETORY PHASE
CORTICAL BINDING
Tc-99m DIMERCAPTOSUCCINIC
ACID (DMSA)
Tc-99m DMSA
METAL CHELATOR50% CORTICAL BINDING VIASULFHYDRYL LINK (MAINLY PCT) 6% EXTRACTION FRACTION DOSE: 2-5 mCi
Tc-99m DMSA
PYELONEPHRITIS RENAL MASS
MIXED
Tc-99m GLUCOHEPTONATE
Tc-99m GLUCOHEPTONATE
12% CORTICAL BINDING (PCT)GLOMERULAR FILTRATION
TUBULAR SECRETIONDOSE: 10 mCi
GALLIUM SCINTIGRAPHY
• INTERSTITIAL NEPHRITIS• ACUTE RENAL FAILURE• ACUTE TUBULAR NECROSIS• AMYLOIDOSIS• VASCULITIS• CHEMOTHERAPY
GALLIUM SCINTIGRAPHY
• BILATERAL MALIGNANCY• LEUKEMIA, LYMPHOMA• BILATERAL OBSTRUCTION• NEPHROTIC SYNDROME• PYELONEPHRITIS• TUBERCULOSIS• WEGENER’S GRANULOMATOSIS