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RENAL SCINTIGRAPHY

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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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shape and function of the kidneys 3 .Purpose  It reveals size. position.

Precautions  pregnancy  breastfeeding 4 .

Method Description  radiopharmaceuticals. The images of the kidney that the camera produces are called renal scans. gamma rays. which can be collected and counted by a special device.   5 . called gamma camera. emit radioactive signals.

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 6  .

Risks  Nuclear medicine procedures are very safe. 7 .

Advantages of renal scintigraphy include:     minimal radiation exposure non-invasive easily reproduced no adverse effects reported 8 .

The most commonly performed investigations are:  dynamic renal imaging (renography) for functional information  static renal imaging for morphological information 9 .

affords a kidney scan and an evaluation of renal function 10 .GFR  Tc-99m MAG3 : the measurement of clearance evaluates the effective renal plasma flow .Radionuclides For dinamic study  Tc-99m DTPA : the measurement of clearance corresponds to the glomerular filtration rate.ERPF For static study  Tc-99m DMSA : the capacity of renal tubuly to take up those molecules.

before and after angioplasty acute renal failure after treatment vesicoureteral reflux in children kidney transplant 11 .Major indications include:      obstructive uropathy .before and after surgery renovascular hypertension .

The upper limit of normal is 5% either side of 50%. ischemic areas in renal hypertension morphological abnormalities such as duplex and horseshoe kidney 12 .STATIC RENAL SCINTIGRAPHY    provides morphological information on each kidney. tumors. A kidney functioning at 15% of more is still useful. DMSA imaging enables assessment of:     size and position of the kidneys differential function . TC 99m DMSA: fixed in the proximal renal tubular cells. cysts.expressed as a percentage of the total function. one whose function is less than 7% is not. parenchymal defects .scars.

Figura 1. Scintigrama renală normală Figura 2.polichistoză renală 13 . Scintigramă renală cu Tc99mGH rinichi stâng mut scintigrafic Figura 3. Scintigramă renală cu Tc99m DMSA .

individual GFR and the pattern of urine excretion. Procedure: Good oral hydration is essential. 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. Patients need to lie down on the camera for a period of 25 minutes after an IV injection 14 . This involves taking serial images of the urinary system for 25 minutes. There is no need for overnight fasting. This test is extremely useful in evaluating: the gross anatomical architecture of the kidneys.RENOGRAM         The production and excretion of urine is a dynamic physiological process which can be easily assessed by performing a Dynamic Renogram study. their relative function.

parenchimal uptake phase (evaluation of tubular secretion).Renal residual activity (RA) – less 50% . Criteria for interpretation: .Segments of renogram.T1/2 of peak – normal 16-20 min Elementary semiology: • Increased transit time: delayed Peak. decreased maximal activity 15 • Obstructive pattern: increased residual activity .Time to peak – normal 3-5 min . BCD – excretion phase. OA – vascular phase. AB . increased RSA • Impaired secretion: decreased renal activity at peak.Renal activity to Peak (RAP) .

Diverse aspecte ale curbelor nefrografice 16 .Figura 7.

VESICO-URETERIC REFLUX SCINTIGRAPHY (VUR) Is indicated in the diagnosis of reflux vesico-ureteral. Dinamic renal scan Tc 99m DTPA: evacuation segment with irregularities. back to the kidney . Mictional nephrography: returning the RF.    17 . Static scan by using the cortical imaging agent Tc 99m DMSA .show diffuse bilateral renal scarring.

Nefroscintigrama micţională (reapariţia radiotrasorului în sistemul pielo-ureteral.Figura 11. în timpul evacuării vezicii urinare) 18 .

one week before the scan. No antihypertensives based on angiotensin converting enzyme inhibitors (ACE). which is one of the important etio-logical factors in young hypertensives. 19 . Adequate oral hydration. The test consists of a Baseline and Post captopril study.CAPTOPRIL RENAL SCINTIGRAPHY (1)      This test is used to evaluate presence of renal artery stenosis and its physiological sig-nificance. The sensitivity and specificity of this test is 85% and 80% respectively.

MAG. Renal scintigraphy may be performed using radiolabeled agents that are excreted primarily by glomerular filtration (e. or 99mTc-mercapto-acetyltriglycine 99mTc .99mTcDTPA) or tubular secretion (orthoiodohippurate131 .IOH.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. technetium 99m diethylenetriamine pentaacetic acid ..3).g. 20 .

With 99mTc-DTPA. Reduced glomerular filtration rate causes slow transit of tubular fluid through the tubules. demonstate progressive accumulation in the affected kidney during the course of the study.3 on the other hand.CAPTOPRIL RENAL SCINTIGRAPHY (3)     Renal function in an ischemic kidney is abruptly reduced after one dose of an ACE in-hibitor. which leads to retention of radio-tracing agent in the tubules. 21 . Tubular agents like 99mTc-Mag. the postcaptopril study demonstrates a marked reduction in uptake of DTPA on the affected side.

Stadializarea nefrogramei în HTA renovasculară 22 .Figura 15.

Figura 16. Nefroscintigrama în HTA renovasculară (în condiţii bazale şi la captopril) 23 .

Transplant Renogram   evaluation of kidney donors and recipients. 24 .  hyperacute or acute rejection: Reduced perfusion while function is relatively maintained. differentiating Acute Tubular Necrosis (ATN) from Graft Rejections.

Radionuclide Evaluation of Renal Function    Estimation of glomerular filtration rate (GFR). Effective Renal Plasma Flow (ERPF) Tubular Extraction Rate (TER) 25 .

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