ABSTRACT
Forty-one uremic cases presenting to the emergency of nephrology section and 10 normal control subjects [N] were assessed clinically and biochemically [serum levels of urea, creatinine, uric acid, sodium, potassium, calcium and phosphorus and estimation of FENa] by abdominal ultrasonography, color Doppler of renal arteries and static [DMSA] and dynamic [DTPA] renal scintigraphy. Clinical assessment, follow up and/or renal biopsy showed that uremic cases had ARF due to acute tubular necrosis [ATN] in 16, obstructive uropathy[OBST] in 12 and CRF in 13. ATN showed very high FENa [17.7 +/- 10.5% vs 0.69 +/- 0.19, 13.4 +/- 12.9 and 10.1 +/- 5.6 in ATN, N, OBST and CRF cases, respectively], normal DTPA perfusion with poor DTPA accumulation, flat renogram with very long T1/2 and very high resistivity indices of intrarenal arteries measured by D. OBST showed pelvic caliectasis by US, impaired DMSA uptake, impaired DTPA perfusion with fair DTPA accumulation, rising renogram during the excretory phase with very long T1/2 and very high resistivity indices of intrarenal arteries measured by D. CRF had very high resistivity indices, impaired DTPA perfusion and accumulation with poor excretion, flat renogram with very long T1/2 and very high resistivity indices of intrarenal arteries measured by D. Follow up of ATN and OBST cases showed incomplete normalization of US, D and [DTPA] renal scintigraphy in spite of clinical and chemical recovery. The study concluded that the most reliable noninvasive tool in discriminating cases presenting acutely with uremia is radioisotopic static [DMSA] and dynamic [DTPA] renal scintigraphy. Moreover, clinical, biochemical, ultrasonographic and Doppler studies are neither specific nor sensitive tools in such field. Also, the kidneys did not usually recover completely after ARE