Abstract
Objective: In the literature, there are many reports comparing relative renal function calculated with Tc 99m DTPA and Tc 99m DMSA in adults and children. However, there is no consensus about the results. As there is indeterminacy in the reliability of Tc 99m DTPA for the calculation of the relative renal functions, we retrospectively designed a study to compare the relative renal functions measured with Tc 99m DMSA and Tc 99m DTPA in adult patients with renal diseasesMaterial and Methods: We retrospectively analyzed the data of 144 patients who applied to Nuclear Medicine Department of three hospitals between 2009 and 2010 and who had both dynamic and static renal imaging. Renal dynamic scintigraphies were compared to the relative function measured using Tc 99m DMSA static scintigraphy. Comparison of relative renal function measurements using dynamic and static renal scintigraphies was performed using Pearson correlation test. The comparison results were expressed with Bland-Altman analysis. Results: The study was conducted with 144 patients and 288 kidneys. Fifty six of patients were male. Mean age was 39.9±15.2 years. Thirty four patients had hydronephrosis, 28 pyelonephritis, 53 renal calculi, 3 chronic renal failure, 2 acute renal failure, 1 benign renal neoplasia, 15 renal atrophy, 8 ureteropelvic junction stenosis. Relative renal function was calculated in Tc 99m DMSA and 99m Tc-DTPA studies. The mean relative renal functions measured with Tc 99m DTPA was 52.54±23.09% and 47.25±23.09, with Tc 99m DMSA 52.85±21.80% and 47.07±21.77% for right and left kidneys, respectively. In bivariate correlation analysis (Pearson) a significant positive correlation was found between the relative renal functions calculated with Tc 99m DTPA and Tc 99m DMSA (r =0.937, p< 0.001). In Bland-Altman plots, the mean difference between two methods was 0.3 and the correlation limits were between 16.2 to -15.5.Conclusion: As a result, we concluded that Tc 99m DTPA is also a good method for the relative renal function evaluation when compared to Tc 99m DMSA scan. Although Tc 99m DMSA is the most reliable method for the calculation of relative renal function, Tc 99m DTPA can be another choice for the calculation of relative renal function without a complementary DMSA scan particularly in patients who require renogram curve and GFR calculations. Conflict of interest:None declared.
Highlights
To measure the relative renal function, renal scintigraphy has been used for a long time
Tc 99m DTPA is used for glomerular filtration rate (GFR) evaluation in mammals because no tubular secretion or reabsorption is observed but it is completely filtered by the glomerulus [8,10,14] In the literature, there are many reports comparing relative renal function calculated with Tc 99m DTPA and Tc 99m DMSA in adults and children
In some of the studies, it is mentioned that Tc 99m DTPA is not as good as Tc 99m DMSA in relative renal function calculation [17,18] As there is indeterminacy in the reliability of Tc 99m DTPA for the calculation of relative renal function and lack of any study related to relative renal function calculation only in adults; we retrospectively designed a study to compare the relative renal functions measured with Tc 99m DMSA and Tc 99m DTPA in adult patients with renal diseases
Summary
To measure the relative renal function, renal scintigraphy has been used for a long time. Tc 99m DMSA binding level to protein in mammals is 90%, this binding prevents significant glomerular filtration and Tc 99m DMSA primarily enters the kidney via peritubular extraction [7]. It is primarily used in humans for cortical imaging and estimation of functional renal mass [8,9,10]. Tc 99m DTPA is used for glomerular filtration rate (GFR) evaluation in mammals because no tubular secretion or reabsorption is observed but it is completely filtered by the glomerulus [8,10,14] In the literature, there are many reports comparing relative renal function calculated with Tc 99m DTPA and Tc 99m DMSA in adults and children. In some of the studies, it is mentioned that Tc 99m DTPA is not as good as Tc 99m DMSA in relative renal function calculation [17,18] As there is indeterminacy in the reliability of Tc 99m DTPA for the calculation of relative renal function and lack of any study related to relative renal function calculation only in adults; we retrospectively designed a study to compare the relative renal functions measured with Tc 99m DMSA and Tc 99m DTPA in adult patients with renal diseases
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