99mTc-DTPA Renography Research Articles

Evaluation of Surgical Outcome of Pelviureteric Junction Obstructive Patients by 99mTc-DTPA Renography

Evaluation of Surgical Outcome of Pelviureteric Junction Obstructive Patients by 99mTc-DTPA Renography

Effects Of Pyeloplasty in Infants with Failing Kidneys Over the Long Term

Objective: The most typical type of obstruction in the upper urinary tract is ureteropelvic junction obstruction or UPJO. The objective of this study was to assess the effectiveness and long-term results of pyeloplasty in children with poorly functioning kidneys. Method: Patients who underwent pyeloplasty at Department of Urology, Rajendra Institute of Medical Science, Ranchi for last twelve years were the subject of a retrospective data study. Postoperative outcome was the parameter under study. Success was measured by either symptom improvement or better drainage on postoperative Tc-99m DTPA renography, which was performed after two months and then yearly after that. Results: 60 individuals were enrolled in the study, with a mean age of 8.5 years (3 months to 12 years), a male-to-female ratio of 2:1, and poor function on the isotope renogram (31%). The ratio of left to right sides was 1.2:1. All patients had dismembered pyeloplasty procedures. 37 patients (66.8%) underwent laparoscopic pyeloplasty, whereas 23 (33.2%) underwent open surgery. 35 patients had follow-up renograms available; of these, 30 showed improved drainage and no further decline in renal function, while 5 displayed an obstructed pattern; of these, 3 patients had noticeably worsened split function, and the other two underwent a second open pyeloplasty. A mean follow-up of 21.5 months revealed a 91% overall success rate. Conclusion: In the pediatric age group, pyeloplasty provides satisfactory intermediate results in kidneys with inadequate function.

PS-BPR03-2: A RARE CASE OF TAKAYASU ARTERITIS INDUCED RENOVASCULAR HYPERTENSION IN A PATIENT WITH CROHN DISEASE

Takayasu arteritis (TA) is chronic inflammatory arteritis affecting large vessels, predominantly the aorta and its main branches. Vascular inflammation occurs wall thickening, fibrosis and stenosis. Arterial stenosis due to TA often causes secondary hypertension. Crohn disease (CD) is chronic granulomatous, inflammatory gastrointestinal disease, It can cause various extraintestinal complications. A few case reports and small case series reported complications of TA and CD. In recently, there are several reports that TA are revealed in patients treated with anti-tumor necrosis factor - alpha antibody for CD. We report a 18 years old male in whom TA was manifested mainly by severe hypertension and proteinuria after infliximab administration for CD. He was diagnosed with CD at the age of 17. He had a great fever and high CRP levels (6.55 mg/dl), and endoscopic examination revealed multiple longitudinal ulcers in the large intestine and ileum. Although, he was treated with adalimumab and 5 -aminosalicylic acid, fever and CRP levels did not improve, Infliximab was administered. Following infliximab administration, his laboratory data revealed renal impairment (blood urea nitrogen level: 13 mg/dl, creatinine level: 1.28 mg/dl), proteinuria (10.0 g/gCr) and he had severe hypertension (about 190/100 mmHg). Both, his plasma aldosterone concentration (PAC) (RIA) and plasma renin activity (PRA) were significantly high (PAC: 798 pg/ml. PRA: 66.2 ng/ml/hr). In addition, magnetic resonance angiography and radioisotope renogram findings revealed stenoses of the right renal artery. Although, a simple CT scan performed 5 months earlier showed no abnormalities in both kidney, contrast-enhanced CT revealed stenoses of the right renal artery, superior mesenteric artery, right renal atrophy, and left renal enlargement. The 99mTc-DTPA Renography reveled severe right renal dysfunction (GFR 14.67/61.21 ml/min). Based on these findings, patient was diagnosed with TA induced renovascular hypertension complicated with CD, and oral administration of prednisolone from 1 mg/kg/day and antihypertensive drugs (amlodipine, doxazosin, and spironolactone) was started. After 14 days treatment, his blood pressure was about 170/90 mmHg. Finally, losartan was administered, his blood pressure was reduced to 120∼150/70∼90 mmHg, and no changes in his serum creatinine levels was observed. We report with a review of the literature.

Improvement of Renal Function after Pyeloplasty Determined by 99mTc DTPA Renogram

Objective: To evaluate the improvement of renal function after pyeloplasty measured by 99mTc-DTPA renography. Materials and Methods: This hospital based quasi experimental study was done in the department of urology, National Institute of Kidney Diseases and Urology (NIKDU) and Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM) from July 2014 to December 2020. Sixty patients were included in this study who underwent Anderson-Hynes (A-H) dismembered pyeloplasty for pelviureteric junction (PUJ) obstruction. All patients were evaluated with diuretic 99mTc- DTPA renogoam before and at 3 and 6 months after operation. Improvement of renal function was evaluated by comparing preoperative and postoperative differential renal function (DRF) and glomerular filtration rate (GFR). Results: Sixty patients with unilateral hydronephrosis due to PUJ obstruction were included in this study. Of these patients 34 male and 26 female with mean age of 15.6 years (ranged from 3 – 38 years). Out of 60 patients, 56.7% had left sided hydronephrosis and 43.3% had right sided hydronephrosis. Diuretic renography was done using 99mTc- DTPA in all patients preoperatively and at 3 and 6 months postoperatively. Preoperative mean DRF and GFR were compared with post-operative findings. The mean preoperative DRF in the study was 16.72 ± 8.35% at baseline which increased to 26.03 ± 7.08% at the end of 3rd month and 28.15 ± 5.84% at the end of 6th month. The mean preoperative GFR was 14.29 ± 6.73 ml/min/1.73 m2 at baseline which increased to 24.13 ± 5.31ml/min/ 1.73 m2 at the end of 3rd month and 27.38 ± 4.78 ml/min/1.73 m2 at the end of 6th month. Conclusion: The result demonstrates that, after pyeloplasty renal function improves. Highest recovery of renal function occurs in children and patients with poor pre-operative DRF and GFR. Bangladesh J. Urol. 2021; 24(2): 155-160

A Comparison of the Renal Function between GFR from Tc-99m DTPA Renography and Serum Creatinine, Serum BUN, eGFR by CKD-EPI Equation, and 24-Hour Urine Creatinine Clearance in Thai Living Related Kidney Donors

Background: There are many methods used to estimate renal function in routine clinical practice. Good correlation between glomerular filtration rate (GFR) by Tc-99m DTPA renal scan and inulin clearance is the gold standard method of determining GFR. Objective: The aim of the present study was to evaluate renal function by GFR by Tc-99m DTPA renography and compare it between serum creatinine (Cr), serum blood urea nitrogen (BUN), estimated GFR (eGFR) by Chronic Kidney Disease Epidemiology Collaboration equation (CKDEPI equation), and 24-hour urine creatinine clearance in Thai living related kidney donors. The secondary aim was to investigate whether age or body mass index (BMI) would have a significant effect to the evaluation of GFR from Tc-99m DTPA renography. Materials and Methods: The present study was a retrospective study that included potential living kidney donors who underwent Tc-99m DTPA renal scan and renogram at Siriraj Hospital (Bangkok, Thailand) to evaluate renal function between January 2011 and January 2018. All included patients had complete GFR data from Tc-99m DTPA renography, serum Cr, serum BUN, eGFR by CKD-EPI equation, and 24-hour urine creatinine clearance. Age, gender, and BMI data were also collected. Results: One hundred twenty cases were included. There were 72 females and 48 males, and the mean age was 36.72±10.22 years with a range of 19 to 58 years. Significant correlation was observed between GFR from Tc-99m DTPA renography and serum Cr, serum BUN, eGFR by CKD-EPI equation, and 24-hour urine creatinine clearance. In contrast, gender and BMI revealed no significance with GFR from Tc-99m DTPA renography. Significant negative correlation was found between GFR from Tc-99m DTPA renography and age. Conclusion: The results of the present study revealed that serum Cr, serum BUN, eGFR by CKD-EPI equation, and 24-hour urine creatinine clearance were reliable methods for evaluating GFR. Older age significantly correlated with reduction of the GFR value from Tc-99m DTPA renography. Keywords: GFR; Renal function; Glomerular filtration rate; Tc-99m DTPA renography; Serum creatinine; BUN; CKD-EPI equation; Urine 24 hours creatinine clearance

Evaluation of renal function after pyeloplasty determined by 99mTc DTPA renogram

Background: Hydronephrosis (HDN) due to pelviureteric junction (PUJ) obstruction is a common congenital anomaly of urinary tract which is generally treated by pyeloplasty. But the extent of functional recovery is still debated. Considering the existing controversies, this study was designed to evaluate the changes of renal function after pyeloplasty measured by 99mTc-DTPA renography.
 Methods: This study was done in the department of urology, National Institute of Kidney Diseases and Urology (NIKDU) and Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital from July 2014 to December 2020. Sixty patients were included in this study and underwent Anderson-Hynes (A-H) dismembered pyeloplasty for PUJ obstruction. All patients were evaluated with diuretic 99mTc-DTPA renogoam before and at 3 and 6 months after pyeloplasty. Improvement of renal function was evaluated by comparing preoperative and postoperative differential renal function (DRF) and glomerular filtration rate (GFR).
 Results: Sixty patients (34 male and 26 female) with unilateral HDN due to PUJ obstruction were included in this study with mean age of 15.6 years (ranged from 3 – 38 years). Out of 60 patients, 56.7% had left sided HDN and 43.3% had right sided HDN. The mean preoperative DRF was 16.72 ± 8.35% at baseline which increased to 26.03 ± 7.08% at the end of 3rd month and 28.15 ± 5.84% at the end of 6th month. The mean preoperative GFR was 14.29 ± 6.73 ml/min/1.73 m2 at baseline which increased to 24.13 ± 5.31ml/min/1.73 m2 at the end of 3rd month and 27.38 ± 4.78 ml/min/1.73 m2 at the end of 6th month.
 Conclusion: The result demonstrates that, after pyeloplasty renal function improves. Highest recovery of renal function noted in patients with poor pre-operative DRF and GFR.
 BIRDEM Med J 2022; 12(2): 142-146

Comparison of double plasma sampling method and gates method for estimation of glomerular filtration rateComparison of double plasma sampling method and gates method for estimation of glomerular filtration rateComparison of double plasma sampling method a

Glomerular filtration rate (GFR) is an important indicator of renal function. Several methods have been applied to calculate GFR in clinical exams. In this study, we evaluated and compared between radionuclide plasma sampling methods (double blood samples, in vitro methods) and in vivo Gate’s method using 99mTc-diethylene triamine penta-acetic acid (99mTc-DTPA) renography. Subejct and method: 42 patients were participated in this study, including 12 patients with obstructive uropathy (group 1) and 30 renal donors (group 2). The administered doses were in a range of 5 – 7mCi. Then, scintigraphy was performed simultaneously after injection, and GFR was calculated by Gate’s method. Blood samples were collected at 60 mins and 120 mins post-injection, which were counted by a thyroid uptake system, and GFR results were determined using a double plasma sample (DPSM) method. Result: The mean GFRs calculated by renography in groups 1 and 2 were 85.8 ± 16.2 (ml/min) and 118.9 ± 13.9 (ml/min), respectively. Meanwhile, using the in vitro DPSM, the mean GFRs in group 1 and 2 were 73.8 ± 15.4 (ml/min) and 117.0 ± 13.0 (ml/min) respectively. They showed a high correlation between the two methods in the two groups (r = 0.86 and 0.71, respectively). Conclusion: Renography is a simple technique but considered inaccurate for determination of GFR. However, in vitro DPSM is rarely used in Vietnam. In this study, Gate’s method corresponded well with plasma sampling method and tended to overestimate the glomerular filtration rate.

Comparison between Three Techniques for Determining Glomerular Filtration Rates: 99mTc-Diethylene Triamine Penta-Acetic Acid Renography, Double Plasma Sampling Method, and Single Plasma Sampling Method in Vietnamese Patients.

Glomerular filtration rate (GFR) is an important indicator of renal function. Many methods have been developed to determine GFR in clinical examinations. This study aims to correlate between radionuclide plasma sampling methods (single and double blood samples, in vitro methods) and in vivo Gate's method using 99mTc-diethylene triamine penta-acetic acid (99mTc-DTPA) renography.Materials and Methods:43 patients underwent this study, including 31 renal donors (Group 1) and 12 patients with obstructive uropathy (Group 2). All patients were administered with a range of 5–7 mCi of 99mTc-DTPA. Then, renography performed simultaneously after injection and GFR calculation followed by Gate's method. Blood samples were collected at 60- and 120-min postinjection, samples were counted by a thyroid uptake system, and GFR was calculated using a single plasma sample method (SPSM) and a double plasma sample method (DPSM).Results:The mean GFRs calculated by Gate's method in Groups 1 and 2 were 85.8 ± 18.2 ml/min and 118.4 ± 13.9 ml/min, respectively. Meanwhile, using the in vitro blood sampling methods (DPSM and SPSM), the mean GFRs in Group 1 were 73.8 ± 15.4 ml/min and 56.4 ± 20.9 ml/min, respectively, and in Group 2 were 116.8 ± 12.9 ml/min and 106.3 ± 18.5 ml/min, respectively. There is a high correlation between Gate's method and DPSM in two groups (r = 0.86 and 0.72, respectively), and a moderate correlation was found between Gate's method and SPSM in both groups (r = 0.49 and r = 0.37, respectively). The two in vitro methods (DPSM and SPSM) revealed that moderate correlation in both groups (r = 0.74 and r = 0.67, respectively) was observed.Conclusion:Renography is a simple method but considered inaccurate for GFR determination. However, in vitro plasma sampling is rarely used in Vietnam. In this study, Gate's method correlated well with DPSM and tended to overestimate GFR. Further, the in vitro methods can be applied to correct the in vivo method as a confirmatory test in some cases.

Feasibility of gamma camera-based GFR measurement using renal depth evaluated by lateral scan of 99mTc-DTPA renography.

Gamma camera-based measurement of glomerular filtration rate (GFR) with 99mTc-diethylenetriaminepentaacetic acid (DTPA) is an established non-invasive measurement of split renal function; however, it is not as accurate as the plasma sample method. Therefore, study into improving the accuracy of such method is clinically relevant. The aim of this study was to elucidate the feasibility of gamma camera-based GFR measurement using renal depth evaluated by lateral scan of 99mTc-DTPA renography and comparing the results with those of GFR using renal depth measured by CT, and three representative formulas. The study population comprised 38 patients (median, 69years; male 28, female 10; median estimated GFR, 67.4ml/min) with renourinary disorders. Scintigraphy was performed after intravenous injection of 370MBq 99mTc-DTPA by dynamic data acquisition for 20min, followed by a bilateral static scan of the abdomen for 3min. All patients underwent computed tomography (CT) within 2months from renography. GFR was calculated by renography using renal depth determined in five ways; lateral scan of 99mTc-DTPA, CT, and three formulas previously created with using weight, height and age. GFRs were compared with estimated GFR (eGFR). The depth of both kidneys measured as described above was compared and evaluated the laterality of the renal depth. The median values of GFR calculated with renal depth determined by 99mTc-DTPA renography, CT, and the three formulas were 87.3, 83.9, 67.8, 68.3, and 71.5ml/min, respectively. All of them correlated significantly with eGFR (r = 0.734, r = 0.687, r = 0.728, r = 0.726, and r = 0.686, respectively), however, no significant difference was observed among five correlation coefficients. Bland-Altman plot revealed that eGFR had error and fixed bias when compared with GFRs calculated using renal depth determined by renography, CT, and Taylor's formula. The depth of both kidneys measured by 99mTc-DTPA renography was equivalent to that measured by CT, however, those measured by the three formulas were significantly smaller than that measured by 99mTc-DTPA renography. The depth of the right kidney was larger than that of the left kidney using all three formulas in all patients. However, CT detected only 66% of patients to have a deeper right kidney than left kidney. Lateral scanning is a feasible procedure to measure renal depth for accurate and reasonable split GFR measurements using 99mTc-DTPA renography.

Determination of the glomerular filtration rate in patients with type 2 diabetes: An assessment of the agreement between 51Cr-EDTA plasma clearance and 99mTc-DTPA plasma clearance, 99mTc-DTPA renography and plasma creatinine prediction equation

AimsTo investigate the agreement of glomerular filtration rate (GFR) determination between 51Cr-ethylenediaminetetraacetic acid (51Cr-EDTA) plasma clearance (GFREDTA) and 99mTc-diethylenetriaminepentaacetic acid (99mTc-DTPA) plasma clearance (GFRDTPA), the Gates 99mTc-DTPA renographic method (GFRGates) and the serum creatinine Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI, GFRSCr) in patients with type 2 diabetes mellitus (T2DM). MethodsNinety-nine T2DM patients underwent GFR determinations simultaneously with 51Cr-EDTA and 99mTc-DTPA (using the slope-intercept technique and the Brochner-Mortensen correction) and also with GFRGates and GFRSCr. ResultsIn the comparison between GFREDTA versus GFRDTPA, GFRGates and GFRSCr, the Bland-Altman statistic provided 0.0 ± 13.2, 17.4* ± 28.8 and −5.9* ± 30.1 (*p < 0.001 for the difference from 0). Lin’s concordance correlation coefficient showed substantial (0.976), poor (0.737) and poor (0.872) agreement, respectively. The proportion of the index results within the 30% and 10% of GFREDTA measurements were 95% and 74% for GFRDTPA, 53% and 19% for GFRGates, and 83% and 26% for GFRSCr, respectively. ConclusionIn T2DM patients, a clinically acceptable agreement is demonstrated between 51Cr-EDTA and 99mTc-DTPA plasma clearance for GFR measurements, suggesting conditional interchangeability between those compounds. Both the CKD-EPI prediction equation and the Gates’ renographic method cannot assess GFR reliably, the latter appearing less unfailing than the former.

Comparison of Gates’ Method and CKD-EPI Equation with Plasma Sample Method for Estimation of GFR

Objectives: Glomerular Filtration Rate (GFR) is an important parameter of kidney function. Many methods are used to measure GFR namely: inulin clearance, double plasma sample method (DPSM), Gates’ method, and equation based method. DPSM has become the gold standard in clinical research. Gates’ method is routinely practiced at National Institute of Nuclear Medicine and Allied Sciences. Chronic kidney disease epidemiology collaboration (CKD-EPI ) equation is encouraged as it is simple and reliable. The aim of the study was assesment of agreement between Gates’ method and CKD-EPI equation with plasma sample method for estimation of GFR.&#x0D; Patients and methods: This cross sectional observational study was carried out at NINMAS, during July 2017 to June 2018. A total of 70 subjects referred for 99mTC-DTPA renography along with GFR estimation, were included in this study.&#x0D; Result: The mean GFR value evaluated by DPSM, Gates’ and CKD-EPI equation were, 81.86 ± 22.42, 86.13 ± 26.70 and 78.48 ± 23.87 mL/min/1.73 m2 respectively. A strong positive correlation (r = 0.922) was found between DPSM and Gates’ method and also between DPSM and CKD-EPI equation (r= 0.930). The Gates’ and CKD-EPI equation also showed strong positive correlation (r = 0.872). The mean difference between DPSM and Gates’, between DPSM and CKD-EPI equation, between Gates’ and CKD-EPI equation were 4.26 ± 10.45, 3.38 ± 8.78 and 7.64 ± 13.09 mL/min/1.73 m2 respectively.&#x0D; Conclusion: Strong positive correlation and excellent agreement were observed between DPSM and Gates’ and also between DPSM and CKD-EPI equation. Strong correlation was also found in between Gates’ and CKD-EPI equation. So, DPSM, Gates’ method and CKD-EPI equation can reflect GFR almost equally and used interchangeably.&#x0D; Bangladesh J. Nuclear Med. 22(1): 36-40, Jan 2019

The application of pyeloureteroplasty in the treatment of children with affected kidney function less than 10

Objective To determine the efficacy and long-term outcome of pyeloureteroplasty in the ureteropelvic junction obstruction (UPJO)patients with poor kidney function(<10%). Methods The data of UPJO patients with poor kidney function treated from January 2006 to September 2016, was retrospectively analyzed. The renal function <10% undergoing pyeloureteroplasty were included. Ipsilateral vesicoureteric reflux, ureterovesical junction obstruction and renal dysplasia were excluded. 39 patients was enrolled. There were 31 boys and 8 girls. The mean age at surgery was 3.1 years old (range 7 months-14 years). There were 36 primary UPJO and 3 extrinsic vessel cases. Twenty-seven cases of UPJO in left side, 9 cases in right side, and 1 case in bilateral side. The preoperative examination included ultrasound, intravenous pyelography (IVU) and 99 mTc DTPA renography. Mean anteroposterior diameter of pelvis was (5.5±2.4)cm before operation (range 3.4-7.4cm); IVU showed non visualized kidney or rim sign.The ill kidneys’mean renal function was (3.25±2.78)% (range 0-9%). Results Open pyeloureteroplasty were performed in the 38 patients, additional nephrectomy was required in 1 because of repeated urinary infection, while the other patients had good prognosis, nephrostomy was kept until 2-3 days’successful clipping. Laparoscope pyeloplasty were performed in one patient with double-J. The patient had urinary infection post operation and was cured. The postoperative examination included ultrasound, intravenous pyelography and 99mTc DTPA renography were performed after 3-6 months. Mean anteroposterior diameter of pelvis was (3.2±1.9)cm (range 2.1-4.5 cm); Intravenous urography showed visualized kidney; Mean renal function was (18.16±13.17)% (9%-27%). There was significant difference between preoperational and postoperational evaluation of renography and pelvis (P 0.05). The mean follow-up time was 10.2 months (range 6-25 months). Conclusions Pyeloureteroplasty could be safe and feasible for the UPJO patients with renal function less than 10%, and could improve the renal function. Key words: Ureteropelvic junction obstruction; Renal function; Radioisotope scanning; Pyeloureteroplasty

Predictors of Recoverability of Renal Function after Pyeloplasty in Adults with Ureteropelvic Junction Obstruction

Background: This study aimed to identify factors predicting the recoverability of renal function after pyeloplasty in adult patients with ureteropelvic junction obstruction. Methods: We retrospectively reviewed 138 adults with unilateral renal obstruction-induced hydronephrosis and who underwent Anderson-Hynes dismembered pyeloplasty from January 2013 to January 2016. Hydronephrosis was classified preoperatively according to the Society for Fetal Urology (SFU) grading system. All patients underwent Doppler ultrasonography, excretory urography, computed tomography, and technetium-99m-diethylenetriamine pentaacetic acid radioisotope (99mTc DTPA) renography before and after surgery. Renal resistive index (RRI) and 99mTc DTPA renography were repeated at 1, 3, 6, and 12 months. Results: Multivariate analysis identified age, renal pelvic type, SFU grade, preoperative RRI, decline of RRI, and renal parenchyma to hydronephrosis area ratio (PHAR) as independent predictors of renal function recoverability after pyeloplasty. However, preoperative RRI and RRI decline were not significantly associated with recoverability of renal function in patients aged >35 years. Lower preoperative RRI, greater decline in RRI, higher PHAR, lower SFU grade, and extrarenal pelvis were associated with greater improvements in postoperative renal function. Conclusions: Preoperative differential renal function cannot independently predict the recoverability of postoperative renal function in adult patients with unilateral renal obstruction-induced hydronephrosis. SFU grade, renal pelvic type, PHAR, preoperative RRI, and decline in RRI were significantly associated with the recoverability of renal function in adult patients aged <35 years, while only SFU grade, renal pelvic type, and PHAR were significantly associated with renal function recoverability in patients aged ≥35 years. Renal function recovery was better in patients younger than 35 years when compared with older patients.

Pituitary gland adenoma with hyperprolactinemia and male erectile dysfunction – A case report

Pituitary gland adenoma with hyperprolactinemia and male erectile dysfunction – A case report

Evaluation of the estimated variables for scaling glomerular filtration rate of renal patients: A repeated measures-based method

Objective. Using a best variable to scale glomerular filtration rate (GFR) is important for clinical practice. The variables, estimated by equations regressed from a healthy population, are usually used in scaling GFR of renal patients. However, because the predicted variables may deviate in renal patients, it is necessary to verify whether these variables can be used to reduce the variability of GFR of renal patients. This study was designed to use repeated measures analyses to identify the best variable for scaling GFR of renal patients. Methods. Patients with non-obstructive renal diseases were enrolled in this study. The absolute GFRs of 99mTc-DTPA renography (gGFR) and plasma clearance (pGFR) were measured. The indices relating to between-subjects variability, such as Passing and Bablok regression, intraclass correlation coefficient (ICC) and concordance correlation coefficient (CCC) were used to identify the best variable from body surface area (BSA), extracellular fluid volume (ECV), lean body mass (LBM), total body water (TBW), body mass index (BMI), and metabolic rate (MR). Results. For the scaled indices related to between-subjects variability, ICC and CCC identified the same ranking sequence (BMI < LBMB(B; Boer) < LBMJ(J; James) < TBW < ECVB(B; Bird) < ECVS(S; Silva) < BSA < MR). In the Passing and Bablok regression, the ratio of residual standard deviation to pooled standard deviation (RSD/PSD) produced the same ranking sequence as that identified by ICC and CCC. Conclusion. The estimated metabolic rate can explain most between-subjects variability of GFR, and seems to be the best variable for scaling GFR of renal patients.

99mTc-DMSA renal scan and 99mTc-DTPA renography findings in patients with horseshoe kidneys: experience of a single institute

Purpose: Horseshoe kidney is a congenital malformation that is found incidentally in many of the asymptomatic patients undergoing 99mTc- DTPA renography and 99mTc-dimercaptosuccinic acid (DMSA) renal scans in the nuclear nephrology division of National Institute of Nuclear Medicine &amp; Allied Sciences (NINMAS). Scan findings of year 2012 and 2013 are demonstrated in this study. Methods: Few of the patients had known ultrasound reports of ectopic positioned or non-visualized kidney and mostly referred to our institute for 99mTc-DTPA renogram. Each diuretic renogram consisted of dynamic renal scan images obtained with camera in both anterior and posterior positions and15% window centered at 140 keV using 64 X 64matrix. Acquisition started with bolus injection of 99mTc-DTPA and dynamic images were acquired at 16-seconds/ frame for 75 frames. Intravenous injection of furosemide (1 mg / kg body weight) was given between 10-15 minutes of the study. They each underwent a 99mTc-DMSA renal cortical scan to confirm the horseshoe kidney. Results: In a 2-year period, 14 patients (5 children and 9 adults) with horseshoe kidney were found with age ranging from 6 to 43 yrs (mean + SD,23.93 ± 9.19) and a male to female ratio of 9:5.Nearly one third of patients (35.8%) were asymptomatic. Urinary tract infections or infection like symptoms were present in five (35.8 %), whereas few showed vague symptoms like flank pain (7.1 %), abdominal pain (7.1 %), gastrointestinal symptoms such as nausea (7.1 %), abdominal distension and fullness (7.1 %). Three kidneys (21.42 %) showed stasis of radioactive urine in the renal pelvic region prior to diuretic injection, suggesting functional obstruction. Only one kidney (7.17 %) showed frank unilateral hydronephrosis and 2(14.28%) showed obstructive nephropathy. There was no incidence of bilateral hydronephrosis. Gross parenchymal disease was seen in 2 (14.28%) and mild parenchymal insufficiency in 4 (28.57%). In 2 (14.28%) cases normal renal function with low GFR were observed. 35.71% patients show horseshoe kidneys with normal function and GFR with variation of sizes of two distinct kidneys. Of the 14 patients, asymmetrical renal cortical function between the two kidneys was found in10 (71.4%). Conclusion: 99mTc-DMSA renal scan and diuretic renogram with 99mTc-DTPA are the simple techniques for the assessment of the patency of horseshoe shaped kidneys, because they can evaluate functional anatomy and urodynamics. DOI: http://dx.doi.org/10.3329/bjnm.v17i1.22488 Bangladesh J. Nuclear Med. 17(1): 25-29, January 2014

Determination of kidney function with 99mTc-DTPA renography using a dual-head camera

Single-head gamma camera renography has been used for decades to estimate kidney function. An estimate of the glomerular filtration rate (GFR) can be obtained using Tc-diethylenetriaminepentaacetic acid (Tc-DTPA). However, because of differing attenuation, an error is introduced when the kidney depth or kidney size is unequal. This error can be reduced using geometric mean data obtained from dual-head renography. The aim of this study was to compare single-head versus dual-head assessment of single kidney function. Thirty-four patients were examined with (a) single-head renography, acquiring counts from the left ventricle and kidneys from a posterior projection, and simultaneously with (b) dual-head renography, acquiring counts from the left ventricle from an anterior projection and kidneys from both anterior and posterior projections using geometric mean values. Single kidney GFR from both models was estimated (GFRcam1 and GFRcam2, respectively) and compared with GFR determined with plasma samples of Tc-DTPA (GFRps). The prediction intervals of GFRcam1 and GFRcam2 compared with GFRps did not differ significantly (SD of GFRcam1-GFRps=17.6 ml/min and SD of GFR2-GFRps=15.5 ml/min; P=0.48). The corresponding coefficients of variation were 16.5 and 14.7%, respectively. There is no difference in variance between GFR estimated from single-head renography and that estimated using dual-head renography. Hence, dual-head camera renography might be useful in daily practice with the potential to provide a better estimate of absolute function in each kidney and the relative kidney function in patients with differing kidney depths and/or malformed kidneys.

Comparative Study of Contrast-Enhanced Ultrasonography and 99mTc-DTPA Renography in the Diagnosis of Kidney Dysfunction

The gold standard to assess renal function is the measurement of glomerular filtration rate (GFR). New ultrasound contrast agent-specific quantitative imaging methods achieved many advances in the visualization of organ perfusion. The aim of this study was to evaluate the value of contrast-enhanced ultrasonography (CEUS) in quantitative diagnosis of chronic kidney dysfunction by comparing ultrasonographic indexes with GFR (urinary clearance of 99mTc-DTPA).

Assessment of renal impairment by non-contrast-enhanced conventional magnetic resonance imaging: comparison with 99mTc-DTPA renography

The aim of this study was to determine whether non-contrast-enhanced magnetic resonance imaging (MRI) can detect three levels of renal impairment by evaluating the differences and agreement with (99m)Tc-diethylenetriamine pentaacetic acid (DTPA) renography. A total of 28 patients with kidney disease were enrolled in the study. MRI findings, including visual corticomedullary differentiation (CMD) on T1- and T2-weighted imaging (T1WI, T2WI), cortical irregularity, the number of renal cysts, and the volume of the kidney, were evaluated for individual kidneys and pairs of kidneys. The differences and agreement between MRI findings and the three levels of renal impairment based on the glomerular filtration rate (GFR) measured using (99m)Tc-DTPA renography were analyzed. All MRI findings except the number of renal cysts in pairs of kidneys were consistent with the patient's classification. The agreement between the patient's classifications based on GFR and that based on the visual CMD on T1WI and T2WI was almost perfect or substantial in both individual kidneys and pairs of kidneys. Non-contrast-enhanced MRI was capable of distinguishing three levels of renal function, including serious renal impairment.

Long-term results of pyeloplasty in poorly functioning kidneys in the pediatric age group

ObjectiveTo determine the efficacy and long-term outcome of pyeloplasty in poorly functioning kidneys in the pediatric age group. MethodRetrospective data analysis was performed on patients who underwent pyeloplasty in 2000–2008. The parameter analyzed was postoperative outcome. Success was defined on the basis of either improvement in symptoms or better drainage on postoperative Tc-99m DTPA renography done after 3 months and yearly thereafter. ResultsA total of 39 patients with a mean age of 8.6 years (4 months to 13 years), and male to female ratio of 3:1, with poor function on isotope renogram (<30%) were included in the study. Left to right side ratio was 1.3:1. Dismembered pyeloplasty was done in all patients. Laparoscopic pyeloplasty was done in 27 (66.7%) and open in 12 (33.3%) patients. Follow-up renograms were available for 35 patients: 31 showed improvement in drainage and no further deterioration in renal function and 4 showed an obstructed pattern; of these, two patients had significant deterioration in split function and the other two underwent redo pyeloplasty by open technique. At a mean follow up of 41.6 months (8–75), overall success rate was 90%. ConclusionPyeloplasty gives good intermediate-term results in poorly functioning kidneys in the pediatric age group.