3. DIURETIC
RENOGRAPHY
DR.V.Siva Subramaniyan
Head, Dept. of Nuclear Medicine ,
SSSIHMS, Prashanthigram, Puttaparthy &
SSSIHMS, Whitefield, Bangalore .

4. OBJECTIVES
 WHAT IS THE CAUSE ?
WRONG WAY
 IS INTERVENTION APPROPRIATE ?
 WHAT IS APPROPRIATE ?
 WHAT IS THE OUT COME ?

5. INDICATIONS
 IDIOPATHIC HYDRONEPHROSIS
 URINARY CALCULI
 URINARY DIVERSION

6. Renal Radiopharmaceuticals

7. RENAL RADIOPHARMACEUTICAL
 I - 131 0I H
 TC - 99 m-DTPA
 TC –99 m- DMSA
 TC- 99 m- MAG 3
 TC -99 m- EC

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

9. SEQUENTIAL ANALYSIS
 IMAGE ANALYSIS
 GFR ESTIAMTION
 RENOGRAPHIC CURVE ANALYSIS
 DIURETIC RESPONSE

11. OBSTRUCTIVE PATTERNS

12. OBSTRUCTIVE PATTERNS

13. Diuretic Response Types

14. NORMAL STUDY

19. ECTOPIC KIDNEYS

24. Super Numerary Kidney

33. FOLLOW UP

37. SSSIHMS
PRASHANTIGRAM_________________________________________________________
Name: Ramalingappa Age / Sex: 30/M Hospital No: 45236/k1
Procedure: Dynamic Renal Date: 20/05/02 N.M N0. RD /4414/02
Tracer: Tc-99m DTPA Dose: 5 Mci Route: Intravenous
Protocol: Gates Diuretic: Lasix 40 mg i.v Time: F 0
Hydration: plenty of oral fluid
Clinical History:
Case of GUTB. Completed treatment. Known case of right poorly functioning kidney. To
check Isotope function of both kidneys and plan for surgery.
IMAGES
INTERPRETATION
K I D N E Y S C O R T E X
Site Size Position Visualization Delineation Defect Contour
RT. Normal ContractedNormal Delayed Nil Nil Irregular
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. Not seen Nil Nil Nil Not seen Nil ---
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
RT. Flat Flat Flat Nil 3 ml 8 %
LT. Vertical Slope L.O.C Type III a 42 ml 82 %
TOTAL GFR 45 ml / min.
IMPRESSION:
Features suggestive of Left impaired functioning Kidney with Rt.side
Non-functioning kidney +.
DR.V.SIVASUBRAMANIYAN,
Consultant Nuclear Medicine Physician
____________________________________________________________________________

38. SSSIHMS
PRASHANTIGRAM____________________________________________________________
Name: Ramalingappa Age / Sex: 30/M Hospital No: 45236/ K1
Procedure: Dynamic Renal Date: 12/09/02 N.M N0. RD/4724/2002
Tracer: Tc-99m DTPA Dose: 5 Mci Route: Intravenous
Protocol: Gates Diuretic: Lasix 40 mg i.v Time: F 0
Hydration: plenty of oral fluid
Clinical History:
A case of Genito- urinary Tuberculosis . Rt. Non- Functioning Kidney and Left Poorly
functioning Kidney. Lt. side DJ stenting done. For follow up Functional evaluation.
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 Nil Nil Nil Nil
LT. Normal Normal Normal Prompt Good Nil Smooth
COLLECTING SYSTE M U R E T E R
Visualisn. Delineation Uptake late fill. Visualisn. Accumulation Insertion
RT. Nil Nil Nil Nil Nil Nil ----
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 % Uptake
RT. –Flat Flat Flat Type II 4 ml 9 %
LT. Vertical Slope Concave Type I 47 ml 91 %
TOTAL GFR 51 ml / min.
IMPRESSION:
Features suggestive of Non- Functioning Rt. Kidney +. The comparison done with the
previous scan RD / 4414 / 2002 reveals that the GFR has become 51 ml / min from the
previous value of 46 ml / min.
DR.V.SIVASUBRAMANIYAN,
Consultant , Nuclear Medicine Physician.
__________________________________________________________________________________

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

49. Captopril Series
Male : 16-68 yrs ; 36.1 +- 13 47
Female : 15-50 yrs ; 34.1 +- 9 16
Total 63

50. Results
Positive : 10 / 63 15%
Negative : 53 / 63 85%

51. CAPTOPRIL STUDY

55. Negative Group
 MALES  FEMALES
 Pre 61 +/- 25 ml  65 +/- 29 ml
 Post 76 +/- 29 ml  82 +/- 20

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

57. THANK YOU