Dr.rasha taha md isotope scanning in nephrology

1. Isotope scanning
in
Nephrology
DR. Rasha Taha, MD
Urology and Nephrology Center
Mansoura University

2. Blood flow - 20% cardiac output to kidneys (1200 ml/min
blood)
Filtration - 20% renal plasma flow filtered by glomeruli
(120 ml/min, 170 L/d)
Tubular secretion
Tubular reabsorption
Endocrine functions
Renal Function

5. Isotope scanning in Nephrology:
either:

7. • Assessment of renal perfusion, function (GFR), and
renal/ureteral obstruction.
• Less desirable for renal cortical details or renal size.

9. Basic Renal Scintigraphy
Void before injection
Void at the end of study

11. International Consensus Committee
Recommendations for Basic Renogram
Tracer: MAG3, (DTPA)
Dose: 2 - 5 mCi adult, minimum 0.5 mCi
peds
Pt. position: supine
Include bladder, heart
Collimator: LEAP

12. DTPA normal

13. DTPA normal

14. Renogram phases
I. Vascular (perfusion) phase: aorta to kidney
(1/2=1 min.)
II. Uptake phase (3-5 min.)
III. Excretory (washout) phase

15. Processing
2-3 minutes: LEFT= 59% RIGHT = 41%

18. Acute and Chronic Renal Failure

20. DTPA

22. Obstruction

23. Diuretic Renal Scan:

24. Diuretic Renal Scan:

29. Captopril Renal Scan
(ACEI Renography)
Evaluation
of Renovascular Hypertension

30. Renovascular Hypertension
Prevalence
<1% unselected population with HTN
Clinical features
-Abrupt onset HTN in child, adult < 30 or > 50y
-Severe HTN resistant to medical Rx
-Unexplained or post-ACEI impairment in renal
function
-If these present - moderate risk of RVH (20-30%)

31. Evaluation of Renovascular Hypertension

32. RAS
Captopril
Angiotensinogen
Angiotensin I
Angiotensin II
Aldosterone Vasoconstriction
HTN
Renin
ACE

33. Gold std: Conventional angiography
Initial non-invasive tests:
ACEI renography
Duplex sonography
Other tests:
MRA - insensitive for distal / segmental R
Renal vein renin levels
Diagnosis of RAS

35. Tracer: Tc-99m MAG3 (or DTPA)
Protocol: 1 day vs. 2 day test
1st day test: baseline scan (1-2 mCi)
followed by post-Capto
scan (8-10 mCi)
2nd day test: post-Captopril scan,
only if abnormal >> baseline
Acquisition: flow & dynamic x 20-30 min.
ACEI Renography
Procedure

38. Captopril Renal Scan MAG3

39. Captopril Renal Scan
MAG 3

41. Captopril Renal Scan
MAG 3

44. Renal Transplant

45. Donor

46. Donor

47. Normal Graft

48. Normal Graft

50. Tc-99m DTPA
Urinoma

51. Acute Tubular Necrosis

53. Rejection/ FK Toxicity

54. Rejection/ Immune suppression
Toxicity

55. Infarction

61. DMSA grading for chronic pyelonephritis
Grade 0: Normal
Grade I: One lesion (or) reduced uptake
(<45%)
Grade II: One lesion+ reduced uptake
Grade III: More than one cortical lesion

62. Normal DMSA scan

63. Normal DMSA scan

64. Grade I PN changes of left kidney