The renal perfusion/excretion determination renogram: a new method of individual renal function determination in obstructive renal disease

The effect of radiopharmaceutical choice on the assessment of the relative renal function in upper urinary tract obstruction

The relative function of the obstructed kidney (RFOK) was assessed in 43 adult patients with upper urinary tract obstruction (UUTO) using 99mTc-DTPA and 131I-ortho-iodohippurate (OIH) dynamic studies and 99mTc-DMSA dynamic and static studies. The patients were divided into five groups according to the duration and degree of obstruction. Findings were as follows: a) in patients with the first occurrence of acute severe obstruction (group 1), the relative glomerular filtration rate (GFR) was significantly less than the relative effective renal plasma flow (ERPF); b) in patients with chronic severe obstruction and long term uroinfection, the relative ERPF decreased significantly compared with the relative GFR; c) the RFOK calculated from the DMSA dynamic study was the same as both the relative GFR or ERPF in any group; d) the RFOK calculated from the DMSA static study seemed to parallel the relative ERPF more closely than the relative GFR, but in group one it was significantly higher than any of three other estimates. It is concluded that 99mTc-DTPA is the radiopharmaceutical of choice in obstructive uronephropathy, but when interpreting the RFOK, the time course and severity of obstruction, the presence or absence of uroinfection should also be considered.

Radionuclide determination of individual kidney function in the treatment of chronic renal obstruction

Differential radionuclide renal scans can be useful in the management of patients with chronic partial obstruction of 1 kidney. The 99mtechnetium diethylenetriaminepentaacetic acid perfusion scan can be used to assess glomerular blood flow. The 131iodine orthoiodohippurate renal scan provides qualitative functional information from scintigrams and quantitative evaluation of effective renal plasma flow to each kidney, as well as a total excretory index. Sequential 99mtechnetium diethylenetriaminepentaacetic acid and 131iodine orthoiodohippurate renal scans were used to assess individual renal function before and after surgical correction of unilateral chronic renal obstruction in 31 patients. The preservation of cortical perfusion on 99mtechnetium diethylenetriaminepentaacetic acid scans indicated that potential existed for partial recovery of renal function. Effective renal plasma flow and excretory index determined in conjunction with the 131iodine orthoiodohippurate scans provided a quantitative assessment of preoperative renal function, an evaluation of the effect of surgery and a sensitive method for long-term evaluation of differential renal function. Correction of ureteropelvic junction obstruction usually resulted in improvement in unilateral renal function. Neither nephrolithotomy nor extended pyelolithotomy diminished renal function in the kidney subjected to an operation and often improved it. Patients with long-standing distal ureteral obstruction had the least improvement in renal function postoperatively.

Anatrophic nephrolithotomy: preservation of renal function demonstrated by differential quantitative radionuclide renal scans

Differential quantitative radionuclide renal scans have been used to confirm that early removal of staghorn calculi by anatrophic nephrolithotomy preserves renal parenchyma without significant renal damage by the surgical procedure. The 99mtechnetium diethylenetriaminepentaacetic acid scan was useful in predicting recovery of function in the involved kidney, while the 131iodine orthoiodohippurate scan provided a quantitative evaluation of the effect of the surgical procedure on individual kidney function. All of 13 consecutive patients evaluated by 131iodine orthoiodohippurate renal scans had stable or improved effective renal plasma flow to the involved kidney and an unchanged or improved total excretory index 6 months after nephrolithotomy.

Regional hypothermia of the kidney: surface or transarterial perfusion cooling? A functional study

Hypothermia reduces ischemic damage if prolonged occlusion of the renal artery is required during an in situ kidney operation. Hypothermia may be achieved by external cooling or by transarterial hypothermic perfusion. External cooling may lower intrarenal temperature heterogeneously. Perfusion techniques via intra-arterial catheters introduced percutaneously are associated with minimal technical difficulties. The 95 patients who underwent extensive hypothermic nephrolithotomy had differential 131iodine hippuran clearance studies preoperatively, and 2 weeks and 6 to 46 months postoperatively. Sixty-three kidneys were cooled by transarterial hypothermic perfusion and 39 were cooled with topical ice slush. In the perfused kidneys renal function had decreased to 80.6 plus or minus 3.7 per cent (mean plus or minus standard error) of the preoperative value 2 weeks postoperatively but recovered to 92.1 plus or minus 4.6 per cent of the pre-treatment value. In the slush-cooled (topically hypothermic) kidneys renal function decreased to 69.7 plus or minus 5.1 per cent of the pre-treatment value 2 weeks postoperatively but recovered to 70.8 plus or minus 4.4 per cent of pre-treatment values 6 months or more postoperatively. Percutaneous transarterial hypothermic renal perfusion seems to offer better preservation of renal function in the clinical situation than does topical ice slush hypothermia.