DIURETIC DIURETIC RENOGRAPHYRENOGRAPHY

DR.V.Siva Subramaniyan

Head, Dept. of Nuclear Medicine ,

SSSIHMS, Prashanthigram, Puttaparthy &

SSSIHMS, Whitefield, Bangalore .

OBJECTIVES

WHAT IS THE CAUSE ?

IS INTERVENTION APPROPRIATE ?

WHAT IS APPROPRIATE ?

WHAT IS THE OUT COME ?

WRONG WAY

INDICATIONS

IDIOPATHIC HYDRONEPHROSIS

URINARY CALCULI

URINARY DIVERSION

Renal Radiopharmaceuticals

RENAL RADIOPHARMACEUTICAL

I - 131 0I H

TC - 99 m-DTPA

TC –99 m- DMSA

TC- 99 m- MAG 3

TC -99 m- EC

Tracer 99 Tc m – DTPA.

Dose : 3-5 mCi

Route : IV injection

Preparation : Proper hydration.

PROCEDURE

SEQUENTIAL ANALYSIS

IMAGE ANALYSIS

GFR ESTIAMTION

RENOGRAPHIC CURVE ANALYSIS

DIURETIC RESPONSE

OBSTRUCTIVE PATTERNS

OBSTRUCTIVE PATTERNS

Diuretic Response Types

NORMAL STUDY

ECTOPIC KIDNEYS

Super Numerary Kidney

FOLLOW UP

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 ____________________________________________________________________________

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

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. 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.

__________________________________________________________________________________

Decrease in % of uptake by > 10%.

Reduction in GFR by > 10%

Worsening of renographic curves

Increased tracer retention

Increased transit time

POSITIVE CRITERIAS

Male : 16-68 yrs ; 36.1 +- 13 47

Female : 15-50 yrs ; 34.1 +- 9 16

Total 63

Captopril Series

Results

Positive : 10 / 63 15%

Negative : 53 / 63 85%

CAPTOPRIL STUDY

Negative Group

MALES

Pre 61 +/- 25 ml

Post 76 +/- 29 ml

FEMALES

65 +/- 29 ml

82 +/- 20

FLOW CHARTHigh risk hypertensive

Color duplex doppler sonography

Renal artery stenosis

Positive Equuivocal Negative

Drug stoppage

Possible Not possible

PTRA Captopril Asprin Exr. renogram

THANK YOU