2. CAPTOPRIL RENOGRAPHY IN
THE EVALUATION OF
HYPERTENSIVE PATIENTS
DR. V. SIVA SUBRAMANIYAN,
DEPT. OF NUCLEAR MEDICINE,
SSSIHMS, PRASHANTHIGRAM.

3. AIMS
♦ I N C I D E N C E O F R.A.S
♦ U T I L I T Y OF CAPTOPRIL
♦E F F E C T O F C A P T O P R I L O N
♦H Y P E R T E N S I V E S

4. PATHOPHYSIOLOGY OF R.V.H

5. I N D I CAT I O N S

6. DISCOVERY
 Accidental invention.
 Majid et al 1983
 Marked decreased renal uptake in
a patient taking Captopril.
 On discontinuation recovery of
renal function.

7. M E T H O D O L O GY
♦ BETA – BLOCKERS AND
ANTIHYPERTENSIVES TO BE
STOPPED 48 – 72 HRS. BEFORE
THE STUDY
BASAL RENOGRAPHY TO BE
PERFORMED.
CLASSICAL CONVENTIONAL
PROCEDURE TO BE FOLLOWED.

8. RENAL SCINTIGRAPHY
 Tracer 99 Tc m – DTPA.
 Dose : 3-5 mCi
 Route : IV injection
 Preparation : Proper hydration.

9. METHODOLOGY
25 – 50 mg CAPTOPRIL TABLETS TO
BE CRUSHED AND ADMINISTERED
ORALLY ALONG WITH 250 ml OF
WATER. 90min. LATER RENAL
SCINTIGRAPHY IS REPEATED WITH
TWICE THE DOSE OF TC 99 m DTPA
USED FOR BASE LINE.

10. INTERPRETAT ION
 Image analysis
 GFR estimation.
 Renographic curve analysis
 Captopril response

11. POSITIVE CRITERIA
 Decrease in % of uptake by > 10%.
 Reduction in GFR by > 10%
 Worsening of renographic curves
 Increased tracer retention
 Increased transit time

12. RENOGRAM TYPES

13. CAPTOPRIL RESPONSE

18. SSSIHMS
PRASHANTIGRAM__________________________________________________________________
Name: Sudha Sree Purna. A Age / Sex: 37/F Hospital No: 53773/k2
Procedure: Captopril Renography Date: 19/08/02 N.M N0. RD /4658&63/2002
Tracer: Tc-99m DTPA Dose: 10 Mci Route: Intravenous
Protocol: Gates Diuretic: Lasix 40 mg i.v Time: F 0
Hydration: plenty of oral fluid
Clinical History: ? Renovasular Hypertension. Right Kidney small on Ultra Sound Scan.
Renal Scan for functional assessment of the Kidneys.
Procedure: After obtaining the Basal study Anti-hypertensives stopped for 2 days. Captopril
50 mg administered orally and after 3 hours Renogram study is repeated.
IMAGES
INTERPRETATION
K I D N E Y S C O R T E X
Site Size Position Visualization Delineation Defect Contour
RT. Normal Normal Normal Prompt Fair Nil Smooth
LT. Normal Normal Normal Prompt Good Nil Smooth
C O L L E C T I N G S Y S T E M U R E T E R
Visualisn. Delineation Uptake late fill. Visualisn. Accumulation Insertion
RT. Prompt Good Increased Nil Faint Trace Normal
LT. Prompt Good Increased Nil Faint Trace Normal
R E N O G R A P H I C C U R V E A N A L Y S I S
PHASE: Uptake Secretory Excretory Diur.response G.F.R % Function
Pre Post Pre Post Pre Post Pre Post Pre Post Pre Post
RT. Vertical Verti Blunted Blunt. Step PlateauType I TypeIII 36 ml 32 ml 46 % 43 %
LT. Vertical Verti Slope Slope Step Step Type I Type I 42 ml 43 ml 54 % 57 %
TOTAL GFR Pre 78 Post 75 ml / min
IMPRESSION:
The Post Captopril Study reveals evidence of Decrease in the Rt. Kidney GFR with
worsening of Curve pattern indicating the High Probabiliy of Rt. Renal Artery Stenosis.
DR.V.SIVASUBRAMANIYAN,
Consultant Nuclear Medicine Physician
___________________________________________________________________________________

21. CAPTOPRIL SERIES
Male : 16-68 yrs ; 36.4 +- 13.6 51
Female : 15-50 yrs ; 34.5 +- 8.9 17
Total 68

22. RESULTS
Positive : 11 / 68 16%
Negative : 57 / 68 84%

23. NEGATIVE GROUP
Males Females
Pre-capto 61 +- 25 ml/ 66 +- 28 ml/
min min
Post-capto 75 +- 29 ml/ 82 +- 30 ml/
min min

24. CONTRAINDICATIONS
♦ B I L A T E R A L R.A.S
♦ DRUG STOPPAGE NOT POSSIBLE
♦ IMPENDING RENAL FAILURE

25. ASPRIN RENOGRAPHY
 Recent invention by
Imanishi et al. 1991
 Substitute to Captopril.

26. PROCEDURE
 Asprin - 20 mg / kg 130 mg
 Oral administration
 Renal scintigraphy one hour later.

27. PATHO PHYSIOLOGY
Prostaglandin
Vasodilatation
Increases glomerular blood flow
Asprin blocks prostaglandin
Decrease in glomerular blood flow.

28. ADVANTAGES
 No stopping of ACEI / Beta blockers.
 No threat of HYPOTENSION.
 No hazard of renal shutdown.

29. DISADVANTAGES
 Positive in 57 % only.
 Sub-groups specificity.
 Selective insensitivity.

30. FLOW CHART
High risk hypertensive
Color duplex doppler sonography
Renal artery stenosis
Positive Equivocal Negative
Drug stoppage
Possible Not possible
PTRA Captopril Asprin Exr. renogram

31. CONCLUSION
Difficult situations.
Definitive role.
Decision making.