RENAL SCINTIGRAPHY

Definition

Administration of small amounts of radioactive substances, called radiotracers, into the body and then imaging the kidneys and bladder with a detector- gamma camera. The images obtained can help in the diagnosis and treatment of certain kidney diseases.
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Purpose

It reveals size, position, shape and function of the kidneys

Precautions

pregnancy

breastfeeding

Method Description

radiopharmaceuticals.
emit radioactive signals, gamma rays, which can be collected and counted by a special device, called gamma camera. The images of the kidney that the camera produces are called renal scans.

Preparation

No preparation is necessary for a kidney nuclear medicine scan.

to study renal artery stenosis, the patient must not take angiotensin converting enzyme inhibitors one week before the scan drinking fluids
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Risks

Nuclear medicine procedures are very safe.

Advantages of renal scintigraphy include:

minimal radiation exposure non-invasive easily reproduced no adverse effects reported

The most commonly performed investigations are:

dynamic renal imaging (renography) for functional information static renal imaging for morphological information

Radionuclides
For dinamic study Tc-99m DTPA : the measurement of clearance corresponds to the glomerular filtration rate- GFR Tc-99m MAG3 : the measurement of clearance evaluates the effective renal plasma flow - ERPF For static study Tc-99m DMSA : the capacity of renal tubuly to take up those molecules; affords a kidney scan and an evaluation of renal function

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Major indications include:

obstructive uropathy - before and after surgery renovascular hypertension - before and after angioplasty acute renal failure after treatment vesicoureteral reflux in children kidney transplant

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STATIC RENAL SCINTIGRAPHY

provides morphological information on each kidney. TC 99m DMSA: fixed in the proximal renal tubular cells. DMSA imaging enables assessment of:

size and position of the kidneys differential function - expressed as a percentage of the total function. The upper limit of normal is 5% either side of 50%. A kidney functioning at 15% of more is still useful; one whose function is less than 7% is not. parenchymal defects - scars, cysts, tumors, ischemic areas in renal hypertension morphological abnormalities such as duplex and horseshoe kidney
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Figura 1. Scintigrama renal normal

Figura 2. Scintigram renal cu Tc99mGH rinichi stng mut scintigrafic

Figura 3. Scintigram renal cu Tc99m DMSA - polichistoz renal

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RENOGRAM

The production and excretion of urine is a dynamic physiological process which can be easily assessed by performing a Dynamic Renogram study. This involves taking serial images of the urinary system for 25 minutes. This test is extremely useful in evaluating: the gross anatomical architecture of the kidneys, their relative function, individual GFR and the pattern of urine excretion. The observations can be displayed in a movie like fashion or "cine mode" which is useful in identifying organic obstructions to the urine outflow system. Procedure: Good oral hydration is essential. There is no need for overnight fasting. Patients need to lie down on the camera for a period of 25 minutes after an IV injection
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Segments of renogram; OA vascular phase; AB - parenchimal uptake phase (evaluation of tubular secretion); BCD excretion phase. Criteria for interpretation: - Renal activity to Peak (RAP) - Time to peak normal 3-5 min - Renal residual activity (RA) less 50% - T1/2 of peak normal 16-20 min Elementary semiology:

Increased transit time: delayed Peak, increased RSA

Impaired secretion: decreased renal activity at peak, decreased maximal activity
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Obstructive pattern: increased residual activity

Figura 7. Diverse aspecte ale curbelor nefrografice

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VESICO-URETERIC REFLUX SCINTIGRAPHY (VUR)

Is indicated in the diagnosis of reflux vesico-ureteral. Dinamic renal scan Tc 99m DTPA: evacuation segment with irregularities; Static scan by using the cortical imaging agent Tc 99m DMSA - show diffuse bilateral renal scarring; Mictional nephrography: returning the RF. back to the kidney .

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Figura 11. Nefroscintigrama micional (reapariia radiotrasorului n sistemul pielo-ureteral, n timpul evacurii vezicii urinare)

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CAPTOPRIL RENAL SCINTIGRAPHY (1)

This test is used to evaluate presence of renal artery stenosis and its physiological sig-nificance, which is one of the important etio-logical factors in young hypertensives. The test consists of a Baseline and Post captopril study; Adequate oral hydration; No antihypertensives based on angiotensin converting enzyme inhibitors (ACE), one week before the scan; The sensitivity and specificity of this test is 85% and 80% respectively.

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CAPTOPRIL RENAL SCINTIGRAPHY (2)

Renal scintigraphy after ACE inhibition demonstrates a decrease in glomerular filtration in the presence of a physiologically significant renal artery stenosis. Renal scintigraphy may be performed using radiolabeled agents that are excreted primarily by glomerular filtration (e.g., technetium 99m diethylenetriamine pentaacetic acid - 99mTcDTPA) or tubular secretion (orthoiodohippurate131 - IOH, or 99mTc-mercapto-acetyltriglycine 99mTc - MAG.3).
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CAPTOPRIL RENAL SCINTIGRAPHY (3)

Renal function in an ischemic kidney is abruptly reduced after one dose of an ACE in-hibitor. With 99mTc-DTPA, the postcaptopril study demonstrates a marked reduction in uptake of DTPA on the affected side. Tubular agents like 99mTc-Mag.3 on the other hand, demonstate progressive accumulation in the affected kidney during the course of the study. Reduced glomerular filtration rate causes slow transit of tubular fluid through the tubules, which leads to retention of radio-tracing agent in the tubules.

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Figura 15. Stadializarea nefrogramei n HTA renovascular

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Figura 16. Nefroscintigrama n HTA renovascular (n condiii bazale i la captopril)

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Transplant Renogram

evaluation of kidney donors and recipients. differentiating Acute Tubular Necrosis (ATN) from Graft Rejections.

hyperacute or acute rejection: Reduced perfusion while function is relatively maintained.

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Radionuclide Evaluation of Renal Function

Estimation of glomerular filtration rate (GFR),

Effective Renal Plasma Flow (ERPF)

Tubular Extraction Rate (TER)

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