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Nuclear Medicine Procedures-2
- 1. Renal: Renogram, Diuretic,and Captopril: Tubular Function, ERPF, and GFR BY DR. ASHRAF ANAS ZYTOON MD, PHD, FJRS MENOUFIYA UNIVERSITY - EGYPT
- 2. Radiopharmacy Radionuclide 99mTc t1/2: 6 hours Energies:140 keV Type: IT, γ, generator Radiopharmaceutical • 99mTc-DTPA (diethylenetriaminepentaacetic acid) • 99mTc-MAG3® (mercaptoacetyltriglycine)
- 3. Adult Dose Range 99mTc:3–20mCi (111–740 MBq) generally 10 mCi (370 MBq) for most studies. Method of Administration • Bolus intravenous injection • If study includes a diuretic use butterfly or IV catheter (furosemide). • ACE inhibitor study: – Captopril (Capoten®) is given PO 1 hour before exam. – Enalapril maleate (Vasotec® intravenous over 3–5 minutes).
- 4. Indications • Evaluation forrenal artery stenosis, obstruction, and/or trauma. • Evaluation of renal tubular function and perfusion (glomerular filtration) for blood flow, parenchyma, and excretion. • Evaluation of renal vascular flow (effective renal plasma flow). • Evaluation of renal obstructive nephropathy and/or hydronephrosis (study with furosemide).
- 5. Indications • Evaluation forrenal (renovascular) hypertension (captopril study). • Evaluation of renovascular hypertension therapy. • Evaluation of abdominal or flank bruits, azotemia, pulmonary edema, retinopathy, and unexplained renal dysfunction. • Detection of acute tubular necrosis. • Evaluation of a kidney transplant.
- 6. Contraindications • Iodine IVcontrast study on same day. • Patient still on adrenal cortical extract (ACE, or angiotensin-converting enzyme) inhibitors or angiotensin receptor blocker (ARB). • Food intake too close to a captopril study will decrease the sensitivity of the test and slow the absorption of the ACE inhibitor. • Beta blockers may affect production of renin.
- 7. Patient Preparation • Identifythe patient. Verify doctor's order. Explain the procedure. • Instruct patient to hydrate well (water) and void just before test. • Physician is to instruct patient to discontinue ACE inhibitors for several days (3–7) before examination. • Instruct patient to be NPO for at least four hours on morning before captopril study. • Post study voiding is recommended to lessen bladder exposure.
- 8. Equipment Camera Large field ofview Collimator low energy, all purpose, or low energy, high resolution
- 9. Normal Results • Assumingtwo kidneys, both kidneys visualizing about the same size and intensities. • Excretion at the same rate. • Smooth renal contour. • Time-to-peak concentration is 3 to 5 minutes. • Clearance t1/2 is 12 to 15 minutes. • GFR (glomerular filtration rate) = 125 mL/minute.
- 10. Artifacts • Some patientsdo not have both kidneys. • Injection problems for flow or bad start. • Infiltration at the injection site can alter renography curves, food within 4 hours of study, pelvic retention, dehydration, hypotension, or full bladder at the start of the study. • False-positives of mechanical obstruction: poor hydration.
- 11. Patient History 1(The patient should answer the following questions). • Do you have a history of kidney disease (e.g., stones, infections)? • Do you have both kidneys? • Are there any recent or planned operations? • Do you have any renal pain? • Are you experiencing urinary frequency or urgency?
- 12. Patient History 2(The patient should answer the following questions). • Do you have any blood in your urine? • Do you have high blood pressure? • Do you have the results of any recent renal laboratory tests? • What medications are you currently taking (please list)? • Female: Are you pregnant or nursing?