Nuclear medicine in acute and chronic renal failure

Congenital oligomeganephronia: computed tomography appearance

We report a case of congenital oligomeganephronia unexpectedly imaged with computed tomography (CT). Oligomeganephronia is a form of renal hypoplasia that leads to renal failure in childhood or adolescence. If encountered, its CT features should suggest the diagnosis and prompt renal biopsy.

The role of technetium-99m MAG3 renal imaging in the diagnosis of acute tubular necrosis of native kidneys

The differential diagnosis for patients with acute renal failure of their native kidneys, as a result of primary intrarenal disease, includes acute tubular necrosis, glomerulonephritis, and interstitial nephritis. The role of MAG3 renography has not been studied in this setting. The authors describe four patients with acute renal failure in whom MAG3 renal imaging reliably identified acute tubular necrosis, as confirmed by follow-up kidney biopsies. In contrast to the poor parenchymal uptake observed in glomerulonephritis and interstitial nephritis, MAG3 shows a distinctive pattern in patients with acute tubular necrosis. For patients with acute renal failure, a renal scan can facilitate decision-making regarding the initiation of therapy.

Ischemic acute renal failure

Underperfusion of the kidneys often results in the development of ischemic acute renal failure. This review summarizes the recent developments in the understanding of the pathophysiology, diagnosis, and treatment of this serious and costly disorder that affects almost 5% of hospitalized patients.

Renal effects of percutaneous stone removal

Preoperative and postoperative renography with 99mTechnetium-diethylene-triamine pentaacetic acid was performed on 33 patients who were free of renal scarring, infection, and obstruction and who underwent percutaneous renal stone removal. Although there was a transient decrease in renal function postoperatively in some patients, statistically significant reductions in renal function occurred only in 1 patient with an arteriovenous malformation that was embolized and in 1 patient who had a postoperative ureteropelvic junction stricture. The creation of more than one nephrostomy tract did not affect the results. In the absence of serious complications, percutaneous nephrostomy does not have a significant effect on renal function.

Aortic dissection, a diagnostic dilemma: case report

A case of type I (type A) aortic dissection proved by postmortem examination could not be fully delineated relative to the type of dissection by dynamic CT as well as three positive contrast aortograms. Small tears in the ascending aorta and their strategic locations can escape even intensive radiologic evaluation. We present a case in which medical therapy was provided and, inappropriately, surgery was not performed.

Predictive value of bedside effective renal plasma flow for renal recovery in severe acute renal failure

Single injection, single blood sample, effective renal plasma flow (ERPF) estimated by 131I-orthoiodohippurate can be performed accurately and conveniently without urine collection at the bedside. The purpose of this study was to determine if ERPF early in the course of severe acute renal failure (ARF) predicts recovery of renal function in hemodynamically stable patients. Over 18 months, ERPF was determined in 33 such patients with ARF in whom an etiologic diagnosis could be established. Eight patients died within 2 months of onset and while on dialysis, did not have an autopsy, and were not considered further. Six patients (Group A) either remained on dialysis after at least 6 months follow-up or had irreversible renal disease at autopsy. In Group B (19 patients, 13 of whom were dialyzed), serum creatinine returned to less than 2.0 mg/dL (n = 16) or was decreasing without dialysis. Peak serum creatinine (Group A 11.2 +/- 1.4; Group B 10.1 +/- 1.3 mg/dL) did not differ between groups. Oliguria was present in 75% of Group A patients and in 25% of Group B patients. Initial ERPFs differed (p less than 0.001) between Group A (90 +/- 11) and Group B (204 +/- 20 mL/min). Initial ERPF was greater than 125 mL/min in 15 Group B patients but in no Group A patients; the false-positive rate was 21% and the false-negative rate was 0%.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute renal failure

ARF is a common clinical problem associated with significant morbidity and mortality. Therefore, rapid and accurate diagnosis is imperative. Initial diagnostic strategies should be directed toward distinguishing among prerenal, renal, and postrenal causes of ARF. This can be done by the use of urinary diagnostic indices in concert with radiologic investigation, renal biopsy, and hemodynamic monitoring when appropriate. Treatment of established ARF should be directed toward maintaining fluid and electrolyte homeostasis and controlling complications resulting from retained nitrogenous waste products. This may necessitate the aggressive use of dialysis. As yet, there is no proven means to prevent ARF or alter the course of ARF once it is established.