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Girard M, Deschamps J, Razzaq S, Lavoie N, Denault A, Beaubien-Souligny W. Emerging Applications of Extracardiac Ultrasound in Critically Ill Cardiac Patients. Can J Cardiol 2023; 39:444-457. [PMID: 36509177 DOI: 10.1016/j.cjca.2022.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/21/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
Point-of-care ultrasound has evolved as an invaluable diagnostic modality and procedural guidance tool in the care of critically ill cardiac patients. Beyond focused cardiac ultrasound, additional extracardiac ultrasound modalities may provide important information at the bedside. In addition to new uses of existing modalities, such as pulsed-wave Doppler ultrasound, the development of new applications is fostered by the implementation of additional features in mid-range ultrasound machines commonly acquired for intensive care units, such as tissue elastography, speckle tracking, and contrast-enhanced ultrasound quantification software. This review explores several areas in which ultrasound imaging technology may transform care in the future. First, we review how lung ultrasound in mechanically ventilated patients can enable the personalization of ventilator parameters and help to liberate them from mechanical ventilation. Second, we review the role of venous Doppler in the assessment of organ congestion and how tissue elastography may complement this application. Finally, we explore how contrast-enhanced ultrasound could be used to assess changes in organ perfusion.
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Affiliation(s)
- Martin Girard
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada; Department of Anaesthesiology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Jean Deschamps
- Department of Intensive Care and Resuscitation, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - André Denault
- Department of Anaesthesiology, Montréal Heart Institute, Montréal, Québec, Canada
| | - William Beaubien-Souligny
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada; Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
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2
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Banks KP, Farrell MB, Peacock JG. Diuretic Renal Scintigraphy Protocol Considerations. J Nucl Med Technol 2022; 50:jnmt.121.263654. [PMID: 35610043 DOI: 10.2967/jnmt.121.263654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
Abstract
Diuretic renal scintigraphy plays a critical diagnostic role by providing a physiologic means for differentiating between obstructive and nonobstructive hydronephrosis as well as assessing the function of the affected kidney. The exam accuracy is highly dependent upon and benefits from close attention to the protocol. This article reviews kidney anatomy and physiology, patient preparation, available radiopharmaceuticals, diuretic administration, acquisition, processing, quantification, and interpretation criteria.
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3
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Boey CY, Yee SY, Amir Hassan SZ, Yahya R, Hashim H. Value of Baseline Post-Transplant MAG3 Renal Scintigraphy in the Evaluation of Graft Function. Transplant Proc 2022; 54:320-324. [DOI: 10.1016/j.transproceed.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/07/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022]
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4
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Ghonge NP, Goyal N, Vohra S, Chowdhury V. Renal transplant evaluation: multimodality imaging of post-transplant complications. Br J Radiol 2021; 94:20201253. [PMID: 34233470 DOI: 10.1259/bjr.20201253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
With advancements in surgical techniques and immuno-suppression, renal transplantation is established as the most effective treatment option in patients with end-stage renal disease. Early detection of renal allograft complications is important for long-term graft survival. Late clinical presentation often causes diagnostic delays till the time allograft failure is advanced and irreversible. Imaging plays a key role in routine surveillance and in management of acute or chronic transplant dysfunction. Multimodality imaging approach is important with ultrasound-Doppler as the first-line imaging study in immediate, early and late post-transplant periods. Additional imaging studies are often required depending on clinical settings and initial ultrasound. Renal functional MRI is a rapidly growing field that has huge potential for early diagnosis of transplant dysfunction. Multiparametric MRI may be integrated in clinical practice as a noninvasive and comprehensive "one-stop" modality for early diagnosis and longitudinal monitoring of renal allograft dysfunctions, which is essential for guiding appropriate interventions to delay or prevent irreversible renal damage. With rapidly increasing numbers of renal transplantation along with improved patient survival, it is necessary for radiologists in all practice settings to be familiar with the normal appearances and imaging spectrum of anatomical and functional complications in a transplant kidney. Radiologist"s role as an integral part of multidisciplinary transplantation team continues to grow with increasing numbers of successful renal transplantation programs across the globe.
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Affiliation(s)
- Nitin P Ghonge
- Department of Radiology, Indraprastha Apollo Hospital, New Delhi, India
| | - Nidhi Goyal
- Department of Radiology, Indraprastha Apollo Hospital, New Delhi, India
| | - Sandeep Vohra
- Department of Radiology, Indraprastha Apollo Hospital, New Delhi, India
| | - Veena Chowdhury
- Department of Radiology, Indraprastha Apollo Hospital, New Delhi, India
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Abstract
Renal transplantation has become the best treatment for the patients with chronic renal insufficiency. The surgical procedures, immunosuppressive regiments and patient follow-up have evolved especially in the last 10 years. However, the diagnosis for renal transplantation dysfunction remained the same in these years. Serum creatinine levels and estimated glomerular filtration rate calculated by serum creatinine based equations are used in routine patient follow-up. Pelvic ultrasonography and color Doppler ultrasonography are used as a first-line imaging method. Assessment of allograft functions both qualitatively and quantitatively are possible using nuclear medicine procedures. Surgical complications, acute tubular necrosis, subacute and/or acute rejection, infections, toxicity due to immunosuppressive medications, complications relating the collecting system, chronic rejection are the main causes for renal function impairment. The imaging procedures can diagnose the worsening of renal transplant function; however, they still lack the ability to differentiate types of rejection as histopathology or differentiate rejection from other causes of allograft dysfunction. The transplant biopsy gives detailed diagnosis for allograft dysfunction, guide the treatment and therefore it is the preferred diagnostic choice in recent years. On recent years, literature on radionuclide imaging is focused on perfusion analysis for the early diagnosis of renal transplant dysfunction and prognostic use of perfusion parameters, and then this article will focus on these studies and their outcome.
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Affiliation(s)
- Bilge Volkan-Salanci
- Assoc Prof. Dept. of Nuclear Medicine, Hacettepe University, Medical School, Ankara, Turkey
| | - Belkis Erbas
- Prof. Dept. of Nuclear Medicine, Hacettepe University, Medical School, Ankara, Turkey.
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6
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Ma H, Gao X, Yin P, Zhao Q, Zhen Y, Wang Y, Liu K, Liu C. Semi-quantification of renal perfusion using 99mTc-DTPA in systolic heart failure: a feasibility study. Ann Nucl Med 2021; 35:187-194. [PMID: 33386522 DOI: 10.1007/s12149-020-01556-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Renal scintigraphy with 99mTc-diethylenetriaminepentaacetic acid (DTPA) may be used to study renal perfusion (RP) in heart failure (HF) patients. The goal of this study was to establish a new method to assess RP in patients with systolic HF. METHODS In this retrospective, single-center, observational study, 86 subjects with left ventricular ejection fraction ≤ 45% and 31 age-matched subjects without HF underwent renal scintigraphy with 99mTc-DTPA. Patients with HF were classified into two categories according to the New York Heart Association (NYHA) functional class, i.e., moderate HF with NYHA functional class I or II and severe HF with NYHA functional class III or IV. The first-pass time-activity curve of the renal scintigraph was recorded. The GFR was determined by Gates' method. The time to peak perfusion activity (Tp), the slope of the perfusion phase (Sp), the slope of the washout phase (Sw), and glomerular filtration rate (GFR) in the study were obtained. Differences between groups were assessed by one-way analysis of variance with the Bonferroni post hoc test and rank-sum test. RESULTS RP in HF was impaired despite comparable GFRs between the control and HF groups. RP in HF was characterized by a longer Tp and a shallower Sp and Sw. The primary parameter (Tp) was significantly prolonged in patients with HF (41.63 ± 12.22 s in severe HF vs. 26.95 ± 6.26 s in moderate HF vs. 17.84 ± 3.17 s in control, P < 0.001). At a cutoff point of 22 s, there was a high sensitivity (0.895) and specificity (0.935) in identifying patients with HF. CONCLUSIONS Renal scintigraphy with 99mTc-DTPA may represent a new and useful method to noninvasively monitor RP abnormalities in HF.
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Affiliation(s)
- Haifang Ma
- Heart Failure Center, The First Hospital of Hebei Medical University, Hebei Medical University, 89 Donggang Road, Shijiazhuang City, 050031, Hebei Province, China.,Cardiovascular Research Center of Hebei Medical University, Shijiazhuang City, Hebei Province, China
| | - Xian Gao
- Health Institute of The First Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, China
| | - Pei Yin
- Division of Nuclear Medicine, The First Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, China
| | - Qingzhen Zhao
- Heart Failure Center, The First Hospital of Hebei Medical University, Hebei Medical University, 89 Donggang Road, Shijiazhuang City, 050031, Hebei Province, China
| | - Yuzhi Zhen
- Heart Failure Center, The First Hospital of Hebei Medical University, Hebei Medical University, 89 Donggang Road, Shijiazhuang City, 050031, Hebei Province, China
| | - Yu Wang
- Heart Failure Center, The First Hospital of Hebei Medical University, Hebei Medical University, 89 Donggang Road, Shijiazhuang City, 050031, Hebei Province, China
| | - Kunshen Liu
- Heart Failure Center, The First Hospital of Hebei Medical University, Hebei Medical University, 89 Donggang Road, Shijiazhuang City, 050031, Hebei Province, China
| | - Chao Liu
- Heart Failure Center, The First Hospital of Hebei Medical University, Hebei Medical University, 89 Donggang Road, Shijiazhuang City, 050031, Hebei Province, China. .,Cardiovascular Research Center of Hebei Medical University, Shijiazhuang City, Hebei Province, China.
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7
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Sugi MD, Joshi G, Maddu KK, Dahiya N, Menias CO. Imaging of Renal Transplant Complications throughout the Life of the Allograft: Comprehensive Multimodality Review. Radiographics 2020; 39:1327-1355. [PMID: 31498742 DOI: 10.1148/rg.2019190096] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The kidney is the most commonly transplanted solid organ. Advances in surgical techniques, immunosuppression regimens, surveillance imaging, and histopathologic diagnosis of rejection have allowed prolonged graft survival times. However, the demand for kidneys continues to outgrow the available supply, and there are efforts to increase use of donor kidneys with moderate- or high-risk profiles. This highlights the importance of evaluating the renal transplant patient in the context of both donor and recipient risk factors. Radiologists play an integral role within the multidisciplinary team in care of the transplant patient at every stage of the transplant process. In the immediate postoperative period, duplex US is the modality of choice for evaluating the renal allograft. It is useful for establishing a baseline examination for comparison at future surveillance imaging. In the setting of allograft dysfunction, advanced imaging techniques including MRI or contrast-enhanced US may be useful for providing a more specific diagnosis and excluding nonrejection causes of renal dysfunction. When a pathologic diagnosis is deemed necessary to guide therapy, US-guided biopsy is a relatively low-risk, safe procedure. The range of complications of renal transplantation can be organized temporally in relation to the time since surgery and/or according to disease categories, including immunologic (rejection), surgical or iatrogenic, vascular, urinary, infectious, and neoplastic complications. The unique heterotopic location of the renal allograft in the iliac fossa predisposes it to a specific set of complications. As imaging features of infection or malignancy may be nonspecific, awareness of the patient's risk profile and time since transplantation can be used to assign the probability of a certain diagnosis and thus guide more specific diagnostic workup. It is critical to understand variations in vascular anatomy, surgical technique, and independent donor and recipient risk factors to make an accurate diagnosis and initiate appropriate treatment.©RSNA, 2019.
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Affiliation(s)
- Mark D Sugi
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Gayatri Joshi
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Kiran K Maddu
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Nirvikar Dahiya
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
| | - Christine O Menias
- From the Department of Radiology, Mayo Clinic, Scottsdale, Ariz (M.D.S., N.D., C.O.M.); and Departments of Radiology and Imaging Sciences (G.J., K.K.M.) and Emergency Medicine (G.J., K.K.M.), Emory University School of Medicine, Atlanta, Ga
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8
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Nuclear Medicine Imaging Techniques of the Kidney. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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9
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Päivärinta J, Oikonen V, Räisänen-Sokolowski A, Tolvanen T, Löyttyniemi E, Iida H, Nuutila P, Metsärinne K, Koivuviita N. Renal vascular resistance is increased in patients with kidney transplant. BMC Nephrol 2019; 20:437. [PMID: 31775670 PMCID: PMC6882025 DOI: 10.1186/s12882-019-1617-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/08/2019] [Indexed: 12/17/2022] Open
Abstract
Background Despite improvement in short-term outcome of kidney transplants, the long-term survival of kidney transplants has not changed over past decades. Kidney biopsy is the gold standard of transplant pathology but it’s invasive. Quantification of transplant blood flow could provide a novel non-invasive method to evaluate transplant pathology. The aim of this retrospective cross-sectional pilot study was to evaluate positron emission tomography (PET) as a method to measure kidney transplant perfusion and find out if there is correlation between transplant perfusion and histopathology. Methods Renal cortical perfusion of 19 kidney transplantation patients [average time from transplantation 33 (17–54) months; eGFR 55 (47–69) ml/min] and 10 healthy controls were studied by [15 O]H2O PET. Perfusion and Doppler resistance index (RI) of transplants were compared with histology of one-year protocol transplant biopsy. Results Renal cortical perfusion of healthy control subjects and transplant patients were 2.7 (2.4–4.0) ml min− 1 g− 1 and 2.2 (2.0–3.0) ml min− 1 g− 1, respectively (p = 0.1). Renal vascular resistance (RVR) of the patients was 47.0 (36.7–51.4) mmHg mL− 1min− 1g− 1 and that of the healthy 32.4 (24.6–39.6) mmHg mL− 1min−1g−1 (p = 0.01). There was a statistically significant correlation between Doppler RI and perfusion of transplants (r = − 0.51, p = 0.026). Transplant Doppler RI of the group of mild fibrotic changes [0.73 (0.70–0.76)] and the group of no fibrotic changes [0.66 (0.61–0.72)] differed statistically significantly (p = 0.03). No statistically significant correlation was found between cortical perfusion and fibrosis of transplants (p = 0.56). Conclusions [15 O]H2O PET showed its capability as a method in measuring perfusion of kidney transplants. RVR of transplant patients with stage 2–3 chronic kidney disease was higher than that of the healthy, although kidney perfusion values didn’t differ between the groups. Doppler based RI correlated with perfusion and fibrosis of transplants.
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Affiliation(s)
- Johanna Päivärinta
- Department of Nephrology, Turku University Hospital, PL 52,Kiinanmyllykatu 4-8, 20521, Turku, Finland. .,Department of Medicine, University of Turku, Turku, Finland.
| | - Vesa Oikonen
- Turku PET Centre, University of Turku, Turku, Finland
| | - Anne Räisänen-Sokolowski
- Department of Pathology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Tuula Tolvanen
- Turku PET Centre, University of Turku, Turku, Finland.,Department of Medical Physics, Turku University Hospital, Turku, Finland
| | | | - Hidehiro Iida
- Turku PET Centre, University of Turku, Turku, Finland
| | - Pirjo Nuutila
- Department of Medicine, University of Turku, Turku, Finland.,Turku PET Centre, University of Turku, Turku, Finland
| | - Kaj Metsärinne
- Department of Nephrology, Turku University Hospital, PL 52,Kiinanmyllykatu 4-8, 20521, Turku, Finland
| | - Niina Koivuviita
- Department of Nephrology, Turku University Hospital, PL 52,Kiinanmyllykatu 4-8, 20521, Turku, Finland.,Department of Medicine, University of Turku, Turku, Finland
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10
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Practical Method for Calculation of Graft Index in Renal Transplant Scintigraphy: A Technical Note. Clin Nucl Med 2019; 44:32-37. [PMID: 30394922 DOI: 10.1097/rlu.0000000000002330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Some quantitative indices have been described for renal transplant scintigraphy in evaluating graft dysfunction, some medical complications, and in predicting early and delayed graft function and long-term graft prognosis. Graft index is very useful and more accurate than many other indices in the prediction of delayed graft function and long-term prognosis. In this technical note, the method of calculation of graft index is shown in detail for the authors who want to use this index in further studies or in clinical practice.
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11
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Unraveling the Cause of Anuria Post Kidney Transplantation by Renal Scintigraphy. Clin Nucl Med 2018; 43:e458-e459. [DOI: 10.1097/rlu.0000000000002286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Taylor AT, Brandon DC, de Palma D, Blaufox MD, Durand E, Erbas B, Grant SF, Hilson AJW, Morsing A. SNMMI Procedure Standard/EANM Practice Guideline for Diuretic Renal Scintigraphy in Adults With Suspected Upper Urinary Tract Obstruction 1.0. Semin Nucl Med 2018; 48:377-390. [PMID: 29852947 PMCID: PMC6020824 DOI: 10.1053/j.semnuclmed.2018.02.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Diego de Palma
- Circolo Hospital and the Macchi Foundation, Varese, Italy
| | | | | | - Belkis Erbas
- Medical School, Hacettepe University, Ankara, Turkey
| | | | | | - Anni Morsing
- Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, Copenhagen, Denmark
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13
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Renal scintigraphy for post-transplant monitoring after kidney transplantation. Transplant Rev (Orlando) 2018; 32:102-109. [DOI: 10.1016/j.trre.2017.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/30/2017] [Accepted: 12/18/2017] [Indexed: 01/22/2023]
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14
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Taylor AT, Folks RD, Rahman AKMF, Polsani A, Dubovsky EV, Halkar R, Manatunga A. 99mTc-MAG 3: Image Wisely. Radiology 2017; 284:200-209. [PMID: 28212051 PMCID: PMC5495132 DOI: 10.1148/radiol.2017152311] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine if commonly administered doses of technetium 99m (99mTc) mertiatide (MAG3) in the range of 300-370 MBq (approximately 8-10 mCi) contribute to image interpretation and justify the resulting radiation exposure. Materials and Methods The respective institutional review boards approved this HIPAA-compliant study and waived informed consent. Baseline and furosemide 99mTc-MAG3 imaging examinations in 50 patients suspected of having renal obstruction and 48 patients suspected of having renovascular hypertension (RVH) were randomly selected from archived databases and were independently scored by three experienced readers without access to 2-second flow images. Readers were blinded to their original scores, and then they rescored each examination with access to high-activity 2-second flow images. Relative renal function was determined after a low activity (62.9 MBq ± 40.7) baseline acquisition for RVH and a high activity (303.4 MBq ± 48.1) acquisition after administration of enalaprilat. Data were analyzed by using random effects analysis of variance and mean and standard error of the mean for the difference between sets of scores and the difference between relative function measurements. Results There was no significant difference in the scores without flow images compared with blinded scores with high-activity flow images for patients suspected of having obstruction (P = .80) or RVH (P = .24). Moreover, there was no significant difference in the relative uptake measurements after administration of low and high activities (P > .99). Conclusion Administered doses of 99mTc-MAG3 in the range of 300-370 MBq (approximately 8-10 mCi) do not affect the relative function measurements or contribute to interpretation of images in patients suspected of having RVH or obstruction compared with administration of lower doses; unnecessary radiation exposure can be avoided by administering doses in the range of 37-185 MBq as recommended incurrent guidelines. © RSNA, 2017.
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Affiliation(s)
- Andrew T. Taylor
- From the Department of Radiology and Imaging Sciences (A.T.T., R.D.F., A.P., R.H.) and Department of Biostatistics and Bioinformatics (A.K.M.F.R., A.M.), Emory University School of Medicine, 1364 Clifton Rd, Atlanta, GA 30322; Veterans Administration Medical Center, Decatur, Ga (A.T.T.); and Departments of Biostatistics (A.K.M.F.R.) and Radiology (E.V.D.), University of Alabama, Birmingham, Ala
| | - Russell D. Folks
- From the Department of Radiology and Imaging Sciences (A.T.T., R.D.F., A.P., R.H.) and Department of Biostatistics and Bioinformatics (A.K.M.F.R., A.M.), Emory University School of Medicine, 1364 Clifton Rd, Atlanta, GA 30322; Veterans Administration Medical Center, Decatur, Ga (A.T.T.); and Departments of Biostatistics (A.K.M.F.R.) and Radiology (E.V.D.), University of Alabama, Birmingham, Ala
| | - A. K. M. Fazlur Rahman
- From the Department of Radiology and Imaging Sciences (A.T.T., R.D.F., A.P., R.H.) and Department of Biostatistics and Bioinformatics (A.K.M.F.R., A.M.), Emory University School of Medicine, 1364 Clifton Rd, Atlanta, GA 30322; Veterans Administration Medical Center, Decatur, Ga (A.T.T.); and Departments of Biostatistics (A.K.M.F.R.) and Radiology (E.V.D.), University of Alabama, Birmingham, Ala
| | - Aruna Polsani
- From the Department of Radiology and Imaging Sciences (A.T.T., R.D.F., A.P., R.H.) and Department of Biostatistics and Bioinformatics (A.K.M.F.R., A.M.), Emory University School of Medicine, 1364 Clifton Rd, Atlanta, GA 30322; Veterans Administration Medical Center, Decatur, Ga (A.T.T.); and Departments of Biostatistics (A.K.M.F.R.) and Radiology (E.V.D.), University of Alabama, Birmingham, Ala
| | - Eva V. Dubovsky
- From the Department of Radiology and Imaging Sciences (A.T.T., R.D.F., A.P., R.H.) and Department of Biostatistics and Bioinformatics (A.K.M.F.R., A.M.), Emory University School of Medicine, 1364 Clifton Rd, Atlanta, GA 30322; Veterans Administration Medical Center, Decatur, Ga (A.T.T.); and Departments of Biostatistics (A.K.M.F.R.) and Radiology (E.V.D.), University of Alabama, Birmingham, Ala
| | - Raghuveer Halkar
- From the Department of Radiology and Imaging Sciences (A.T.T., R.D.F., A.P., R.H.) and Department of Biostatistics and Bioinformatics (A.K.M.F.R., A.M.), Emory University School of Medicine, 1364 Clifton Rd, Atlanta, GA 30322; Veterans Administration Medical Center, Decatur, Ga (A.T.T.); and Departments of Biostatistics (A.K.M.F.R.) and Radiology (E.V.D.), University of Alabama, Birmingham, Ala
| | - Amita Manatunga
- From the Department of Radiology and Imaging Sciences (A.T.T., R.D.F., A.P., R.H.) and Department of Biostatistics and Bioinformatics (A.K.M.F.R., A.M.), Emory University School of Medicine, 1364 Clifton Rd, Atlanta, GA 30322; Veterans Administration Medical Center, Decatur, Ga (A.T.T.); and Departments of Biostatistics (A.K.M.F.R.) and Radiology (E.V.D.), University of Alabama, Birmingham, Ala
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15
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A New Quantitative Index for Baseline Renal Transplant Scintigraphy With 99mTc-DTPA in Evaluation of Delayed Graft Function and Prediction of 1-Year Graft Function. Clin Nucl Med 2016; 41:182-8. [DOI: 10.1097/rlu.0000000000001020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Evaluation of Renal Transplant Scintigraphy and Resistance Index Performed Within 2 Days After Transplantation in Predicting Long-Term Graft Function. Clin Nucl Med 2015; 40:548-52. [DOI: 10.1097/rlu.0000000000000789] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Taylor AT. Radionuclides in nephrourology, part 1: Radiopharmaceuticals, quality control, and quantitative indices. J Nucl Med 2014; 55:608-15. [PMID: 24549283 DOI: 10.2967/jnumed.113.133447] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Radionuclide renal scintigraphy provides important functional data to assist in the diagnosis and management of patients with a variety of suspected genitourinary tract problems, but the procedures are underutilized. Maximizing the utility of the available studies (as well as the perception of utility by referring physicians) requires a clear understanding of the clinical question, attention to quality control, acquisition of the essential elements necessary to produce an informed interpretation, and production of a report that presents a coherent impression that specifically addresses the clinical question and is supported by data contained in the report. To help achieve these goals, part 1 of this review covers information that should be provided to the patient before the scan, describes the advantages and limitations of the available radiopharmaceuticals, discusses quality control elements needed to optimize the study, summarizes approaches to the measurements of renal function, and focuses on recommended quantitative indices and their diagnostic applications. Although the primary focus is the adult patient, aspects of the review also apply to the pediatric population.
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Affiliation(s)
- Andrew T Taylor
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Helck A, Wessely M, Notohamiprodjo M, Schönermarck U, Klotz E, Fischereder M, Schön F, Nikolaou K, Clevert DA, Reiser M, Becker C. CT perfusion technique for assessment of early kidney allograft dysfunction: preliminary results. Eur Radiol 2013; 23:2475-81. [DOI: 10.1007/s00330-013-2862-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 03/12/2013] [Accepted: 03/30/2013] [Indexed: 10/26/2022]
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Yamamoto A, Zhang JL, Rusinek H, Chandarana H, Vivier PH, Babb JS, Diflo T, John DG, Benstein JA, Barisoni L, Stoffel DR, Lee VS. Quantitative evaluation of acute renal transplant dysfunction with low-dose three-dimensional MR renography. Radiology 2011; 260:781-9. [PMID: 21771953 DOI: 10.1148/radiol.11101664] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To assess prospectively the ability of quantitative low-dose three-dimensional magnetic resonance (MR) renography to help identify the cause of acute graft dysfunction. MATERIALS AND METHODS This HIPAA-compliant study was approved by the institutional review board, and written informed consent was obtained. Between December 2001 and May 2009, sixty patients with transplanted kidneys (41 men and 19 women; mean age, 49 years; age range, 22-71 years) were included. Thirty-one patients had normal function and 29 had acute dysfunction due to acute rejection (n = 12), acute tubular necrosis (ATN) (n = 8), chronic rejection (n = 6), or drug toxicity (n = 3). MR renography was performed at 1.5 T with three-dimensional gradient-echo imaging. With use of a multicompartment renal model, the glomerular filtration rate (GFR) and the mean transit time (MTT) of the tracer for the vascular compartment (MTT(A)), the tubular compartment (MTT(T)), and the collecting system compartment (MTT(C)) were calculated. Also derived was MTT for the whole kidney (MTT(K) = MTT(A) + MTT(T) + MTT(C)) and fractional MTT of each compartment (MTT(A/K) = MTT(A)/MTT(K), MTT(T/K) = MTT(T)/MTT(K), MTT(C/K) = MTT(C)/MTT(K)). These parameters were compared in patients in the different study groups. Statistical analysis was performed by using analysis of covariance. RESULTS There were significant differences in GFR and MTT(K) between the acute dysfunction group (36.4 mL/min ± 20.8 [standard deviation] and 177.1 seconds ± 46.8, respectively) and the normal function group (65.9 mL/min ± 27.6 and 140.5 seconds ± 51.8, respectively) (P < .001 and P = .004). The MTT(A/K) was significantly higher in the acute rejection group (mean, 12.7% ± 2.9) than in the normal function group (mean, 8.3% ± 2.2; P < .001) or in the ATN group (mean, 7.1% ± 1.4; P < .001). The MTT(T/K) was significantly higher in the ATN group (mean, 83.2% ± 9.2) than in the normal function group (mean, 72.4% ± 10.2; P = .031) or in the acute rejection group (mean, 69.2% ± 6.1; P = .003). CONCLUSION Low-dose MR renography analyzed by using a multicompartmental tracer kinetic renal model may help to differentiate noninvasively between acute rejection and ATN after kidney transplantation.
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Affiliation(s)
- Akira Yamamoto
- Department of Radiology, New York University School of Medicine, 660 First Ave, 4th Floor, New York, NY 10016, USA.
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Comprehensive Assessment of Renal Function and Vessel Morphology in Potential Living Kidney Donors. Invest Radiol 2009; 44:705-11. [DOI: 10.1097/rli.0b013e3181b35a70] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Sanches A, Etchebehere ECSC, Mazzali M, Filho GA, Lima MCL, Santos AO, Ramos CD, Cardinalli I, Billis A, Camargo EE. The accuracy of (99m)Tc-DTPA scintigraphy in the evaluation of acute renal graft complications. Int Braz J Urol 2009; 29:507-16. [PMID: 15748304 DOI: 10.1590/s1677-55382003000600005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2003] [Accepted: 11/14/2003] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Renal scintigraphy has been used for many years in the evaluation of renal transplants and can help in the diagnosis of graft complications, leading to prompt clinical management and preventing further deterioration of renal function. The purpose of this study was to evaluate the overall accuracy of renal scintigraphy with (99m)Tc-DTPA in the diagnosis of acute renal graft complications. MATERIALS AND METHODS Seventy-six scintigraphic studies performed in 55 patients (ages ranging from 6 to 65 years), were reviewed. Scintigraphy results were compared to biopsies performed within 5 days of imaging. (99m)Tc-DTPA study was performed within a mean time of 19 days after kidney transplants. Dynamic images were performed in the anterior position of the abdomen and pelvis every 2 seconds for 80 seconds (flow phase) and every 15 seconds for 30 minutes (functional phase), after an intravenous injection of 370 MBq (10 mCi) of (99m)Tc-DTPA. RESULTS The scintigraphic results were concordant with the biopsies in 86% of the cases studied. The sensitivities of renal scintigraphy for detection of acute tubular necrosis (ATN), acute rejection (AR) and cortical necrosis (CN) were 98%, 87% and 100%, respectively. Specificities and accuracies for detection of ATN, AR and CN were 89%, 86% and 100%, and 95%, 87% and 100%, respectively. CONCLUSION Renal scintigraphy with (99m)Tc-DTPA showed a good overall accuracy in the detection of acute renal graft complications. It can be used as a reliable tool in the routine evaluation of these patients.
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Affiliation(s)
- Adelina Sanches
- Division of Nuclear Medicine, Department of Radiology, Campinas State University, UNICAMP, Campinas, São Paulo, Brazil
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Kalkman E, Paterson C. Radionuclide imaging of the renal tract: principles and applications. IMAGING 2008. [DOI: 10.1259/imaging/25131026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Prediction of Long-Term Renal Transplant Allograft Function From Day 3 Post-transplant Tc-99m MAG3 Scintigraphy. Clin Nucl Med 2008; 33:102-5. [DOI: 10.1097/rlu.0b013e31815f2468] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Koh TS, Zhang JL, Ong CK, Shuter B. A biphasic parameter estimation method for quantitative analysis of dynamic renal scintigraphic data. Phys Med Biol 2006; 51:2857-70. [PMID: 16723771 DOI: 10.1088/0031-9155/51/11/012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Dynamic renal scintigraphy is an established method in nuclear medicine, commonly used for the assessment of renal function. In this paper, a biphasic model fitting method is proposed for simultaneous estimation of both vascular and parenchymal parameters from renal scintigraphic data. These parameters include the renal plasma flow, vascular and parenchymal mean transit times, and the glomerular extraction rate. Monte Carlo simulation was used to evaluate the stability and confidence of the parameter estimates obtained by the proposed biphasic method, before applying the method on actual patient study cases to compare with the conventional fitting approach and other established renal indices. The various parameter estimates obtained using the proposed method were found to be consistent with the respective pathologies of the study cases. The renal plasma flow and extraction rate estimated by the proposed method were in good agreement with those previously obtained using dynamic computed tomography and magnetic resonance imaging.
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Affiliation(s)
- T S Koh
- Center for Modeling and Control of Complex Systems, School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore
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Sener M, Torgay A, Akpek E, Aktas A, Colak T, Karakayali H, Arslan G, Haberal M. The effect of anesthetic technique on early postoperative renal function after donor nephrectomy: a preliminary report. Transplant Proc 2005; 37:2023-7. [PMID: 15964329 DOI: 10.1016/j.transproceed.2005.03.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2004] [Indexed: 11/17/2022]
Abstract
General and regional anesthesia may both be used successfully in donor nephrectomy although the use of regional anesthesia is rare. We compared the remaining kidney function during general (n = 10) versus combined spinal-epidural (n = 10) anesthesia for donor surgery. Blood biochemistry data were collected preoperatively and postoperatively, while renal function was assessed by scintigraphy and urine levels of microalbumin, creatinine, Na, K, Ca and creatinine clearance rate were measured/calculated in 24-hour urine samples collected preoperatively and on postoperative day 2. There were no differences preoperatively and on postoperative day 2 with respect to glomerular filtration rate, microalbuminuria, or creatinine clearance rate (P > .05 for all). There were also no differences between the groups with respect to other scintigraphic findings preoperatively and on postoperative day 2 (P > .05 for all). The results suggest that general or combined spinal-epidural anesthesia for donor nephrectomy have similar effects on the remaining donor kidney function.
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Affiliation(s)
- M Sener
- Department of Anesthesiology, Baskent University, Faculty of Medicine, Dadaloglu Mahallesi 39, sokak no. 36, Adana, Yuregir 02150, Turkey.
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Omar AM, Al-Saeed T, Gawish AE, Tailji S, Ibrahim AK, Collier BD, Elgazzar AH. Renography within 1 hour of renal transplantation: technical feasibility and clinical utility. Med Princ Pract 2005; 14:111-4. [PMID: 15785104 DOI: 10.1159/000083922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2003] [Accepted: 04/24/2004] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Renographies obtained within 1 h of renal transplantation were studied prospectively to evaluate their technical feasibility and potential clinical impact on successful treatment of immediate posttransplantation complications such as arterial or venous thrombosis, which require prompt diagnosis and management. SUBJECTS AND METHODS During December 1996 to December 1998, 127 renal transplants were performed. Ninety-four patients had complete renographic studies within 1 h of surgery. It was not possible to perform renography on 26 patients who were not sent to the Department of Nuclear Medicine within 1 h of transplant and 7 other patients who could not undergo a complete renogram because of their postoperative condition. RESULTS There was no complication attributed to transporting patients to the Department of Nuclear Medicine for these studies so soon after surgery. Of the 94 renographies obtained immediately following transplant surgery 46 were abnormal. However, when compared with the usual policy of obtaining baseline renograms between 12 and 72 h after surgery, treatment was changed for only 2 patients. Radionuclide renography within 1 h of transplant surgery was technically feasible. CONCLUSION Based on the results of this study the clinical utility of obtaining renography within 1 h posttransplant was minimal and hence we recommended that it should not be performed routinely but could be used on an individual basis when imminent intervention is highly likely.
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Affiliation(s)
- Abdel Moneim Omar
- Department of Nuclear Medicine, Organ Transplantation Center, Ministry of Health, Kuwait
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Sener M, Torgay A, Akpek E, Colak T, Karakayali H, Arslan G, Haberal M. Regional versus general anesthesia for donor nephrectomy: Effects on graft function. Transplant Proc 2004; 36:2954-8. [PMID: 15686669 DOI: 10.1016/j.transproceed.2004.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Various general and regional anesthesia methods are used successfully in living-donor kidney transplantation. This study compared kidney graft function after general versus combined spinal-epidural anesthesia for donor nephrectomy. The study groups included recipients who received grafts from donors who had undergone nephrectomy under general anesthesia (GA group; n=10), and recipients who received grafts from donors who had combined spinal-epidural anesthesia (CSE group, n=10). Standard continuous epidural anesthesia was administered during all transplantations. Graft function was assessed using scintigraphy and Doppler ultrasonography on days 3 and 7. Urine levels of microalbumin, creatinine, and creatinine clearance rate were measured/calculated in 24-hour urine samples collected on postoperative days 3 and 7. There were no differences on either day 3 or day 7 with respect to glomerular filtration rate, microalbuminuria, or creatinine clearance rate (P >.05 for all). There were also no differences between the groups with respect to other scintigraphic findings on day 3 or day 7 (P >.05 for all). Ultrasonography on day 7 showed significantly higher mean peak systolic flow in the main renal artery in the CSE group than in the GA group (P=.035). The results suggest that GA and CSE for donor nephrectomy have similar effects on kidney graft function in recipients.
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Affiliation(s)
- M Sener
- Baskent University Faculty of Medicine, Department of Anesthesiology, Dadaloglu mah, Adana, Turkey.
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Abreu SC, Goldfarb DA, Derweesh I, Thornton J, Urbain JL, Mascha E, Steinberg AP, Kaouk JH, Flechner S, Modlin C, Krishnamurthi V, Novick AC, Gill IS. Factors related to delayed graft function after laparoscopic live donor nephrectomy. J Urol 2004; 171:52-7. [PMID: 14665842 DOI: 10.1097/01.ju.0000098819.79442.ce] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Delayed graft function after live donor transplantation affects 5% to 10% of recipients regardless of procurement technique. This delay in function is associated with an increased risk of rejection and decreased graft survival. In the present study we critically assess allograft recovery to identify the risk factors related to delayed graft function. MATERIALS AND METHODS We retrospectively reviewed donor and recipient medical records from 100 consecutive laparoscopic live donor nephrectomies from August 1997 to October 2001. Four criteria were used to classify delayed graft function: I) requirement of dialysis in postoperative week 1, II) creatinine 2.5 mg/dl or greater at postoperative day 5, III) time to half peak activity (mercaptoacetyltriglycine renal scan) at postoperative day 5 greater than 12.2 minutes (normal range 1 to 12.2) and IV) time to peak activity (mercaptoacetyltriglycine renal scan) at day 5 greater than 6.5 minutes (normal range 2.1 to 6.5). Patients could qualify for multiple outcome categories. Patients who did not match any of these criteria were classified as having normal renal function (outcome 0). RESULTS The number of patients in the delayed graft function categories were 5 with outcome I, 14 with outcome II, 39 with outcome III and 24 with outcome IV. There were 23 patients represented in more than 1 category and 59 patients were classified as having normal function. Recipient age, donor/recipient gender relationship, unrelated highly mismatched donors and cold/total preservation time were identified as risk factors related to impaired early renal function recovery. None of the variables related to the laparoscopic technique itself represented risk factors for delayed graft function. CONCLUSIONS Female donor kidneys into male recipients and highly HLA mismatched donors represent factors that may be controlled by donor selection when feasible. All attempts should be made to decrease cold ischemia time and, therefore, total preservation time. Prolonged carbon dioxide pneumoperitoneum, warm ischemia time, renal artery length or use of right kidney did not adversely affect the functional outcome of the allografts procured laparoscopically.
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Affiliation(s)
- Sidney C Abreu
- Section of Laparascopic and Minimally Invasive Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Ohio 44195, USA
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Hosotani Y, Takahashi N, Kiyomoto H, Ohmori K, Hitomi H, Fujioka H, Aki Y, Fukunaga M, Yuasa S, Mizushige K, Kohno M. A new method for evaluation of split renal cortical blood flow with contrast echography. Hypertens Res 2002; 25:77-83. [PMID: 11924730 DOI: 10.1291/hypres.25.77] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The recent development of contrast echography has made renal enhancement possible through an intravenous injection of microbubble-based contrast. In animal models, tissue perfusion can be quantified using contrast echography by measurement of the rate at which microbubbles replenish tissue after their ultrasound-induced destruction. Our purpose in this study was to evaluate renal blood flow with contrast echography in humans. To increase the sensitivity for microbubbles, we used a combination of power Doppler harmonic and intermittent imaging. The pulsing interval (PI) was changed from 10 cardiac cycles to 1 cardiac cycle during an intravenous infusion of the contrast agent, and alterations in the intensity of the renal cortex were represented as a decline ratio (DR). In 24 patients with various renal diseases, we were able to observe all 48 kidneys with adequate enhancement of the renal cortex. At PI of 10 cardiac cycles, the enhancement was homogeneous and strong, while, obviously, changing PI from 10 to 1 cardiac cycles caused a decline of enhancement. An excellent correlation was found between DR using contrast echography and renal plasma flow determined by clearance and radionuclide measurements. An excellent correlation was found between the DR values determined by contrast echography and the renal plasma flow values determined using clearance and radionuclide measurements. These results suggest that DR may be useful for evaluation of both total and split renal blood flow. Thus the contrast echographic method presented here could succeed in assessing renal cortical blood flow less invasively than conventional methods in humans.
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Affiliation(s)
- Yoko Hosotani
- Second Department of Internal Medicine, Kagawa Medical University, Japan
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