RENAL SCINTIGRAPHY Prepared and Presented by Paul 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 I Initial injection Dynamic

IVP Phase II Cortical Transit

IVP Phase III Excretory

IVP Phase III Excretory

IVP Phase III Excretory

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 ORTHIODOHIPPURATE Tc-99m MERCAPTOACEYTL- TRIGLYCINE (MAG3)

I-131 HIPPURAN 20% FILTERED 80% SECRETED DOSE: 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 DIETHYLENETRIAMINE PENTAACETIC ACID (DTPA) IODINATED CONTRAST Gd-DTPA

Tc-99m DTPA GLOMERULAR FILTRATION METAL CHELATOR 20% EXTRACTION FRACTION DOSE: 5-20 mCi

Tc-99m DTPA IMAGING FLOW (ARTERIAL) UPTAKE (NEPHROGRAM) EXCRETION (“CORTICAL TRANSIT”)

RENOVASCULAR HYPERTENSION ABRUPT ONSET HTN 55 YRS SEVERE/MALIGNANT HTN REFRACTORY HTN

RENOVASCULAR HYPERTENSION EPIGASTRIC BRUIT MOD HTN WITH VASCULAR DZ ACE INHIBITOR-INDUCED RF

RENOVASCULAR HYPERTENSION <1% HYPERTENSIVE PATIENTS ATHEROSCLEROSIS FIBROMUSCULAR DYSPLASIA RAS NOT NECESSARILY RVH

CAPTOPRIL RENOGRAPHY MEDICATION HISTORY DISCONTINUE ACE INHIBITORS SERUM CHEMISTRY (BUN/Cr)

CAPTOPRIL RENOGRAPHY ORAL AND IV HYDRATION BP MONITORING 25 MG CAPTOPRIL ORALLY 10 mCi MAG 3 AND LASIX

CAPTOPRIL RENOGRAPHY PHYSIOLOGY OF RVH DIMINISHED RBF RENIN-ANGIOTENSIN EFFERENT ARTERIOLE

CAPTOPRIL RENOGRAPHY PROLONGED TIME TO PEAK CORTICAL 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 MIN OBSTRUCTED: >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 REPAIR Tc-99m MAG3 FLOW UPTAKE CORTICAL TRANSIT EXCRETORY PHASE

CORTICAL BINDING Tc-99m DIMERCAPTOSUCCINIC ACID (DMSA)

Tc-99m DMSA METAL CHELATOR 50% CORTICAL BINDING VIA SULFHYDRYL LINK (MAINLY PCT) 6% EXTRACTION FRACTION DOSE: 2-5 mCi

Tc-99m DMSA PYELONEPHRITIS RENAL MASS

MIXED Tc-99m GLUCOHEPTONATE

12% CORTICAL BINDING (PCT) GLOMERULAR FILTRATION TUBULAR SECRETION DOSE: 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