Date post: | 07-Feb-2015 |
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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