99mTc-DTPA Diuretic Renography with 3 hours late output fraction in the evaluation of hydronephrosis in children

ABSTRACT Objective: Dynamic renal scintigraphy complemented by late gravity assisted postvoid images to 60 minutes is a frequently used diagnostic test in the evaluation of hydrone- phrosis. The objective of this study is to evaluate the effectiveness in acquiring images at 180 minutes to calculate the late output fraction (LOF) of 99mTc-DTPA in the diagno- sis of ureteropelvic junction obstruction (UPJO). Materials and Methods: A retrospective study of 177 patients (196 renal units) of sus- pected cases of clinical UPJO was conducted. The patients were submitted to at least two dynamic renal scintigraphies of 99mTc-DTPA, with the addition of furosemide (F0), with a mean age of 4.3±3.8 years for the first study, and a follow-up of 2.7±2.5 years. Results: For diagnosis based on renal curves, a 100% sensitivity, 82.2% specificity, positive predictive value (PPV) of 10.4% and negative predictive value (NPV) of 100% were estimated. For diagnosis based on LOF, a 100% sensitivity, 96.3% specificity, PPV of 35.7% and NPV of 100% were estimated. Conclusion: A LOF <10% is indicative of UPJO, and a LOF ≥15% is indicative of no UPJO. The data demonstrate that LOF presents equivalent sensitivity and NPV, and higher specificity and PPV in comparison to diagnosis based on renal curves, and is useful in the evaluation and follow-up of suspected cases of UPJO.

Left ureteral appendiceal interposition: Exercise caution and do not be mislead by postoperative radiological obstruction

ABSTRACT Postoperative imaging after appendiceal ureteral interposition may be difficult to interpret, misguiding the urologist towards intervention. We present a case in which radiological obstruction was not endorsed by a 99TcDTPA nephrogram, with favorable outcome after conservative treatment.

Nontarget area and threshold selection in 99mTc-DTPA orbital SPECT/CT imaging inthyroid associated ophthalmopathy / 中南大学学报(医学版)

To compare diagnostic value of 4 kinds of target-to-nontarget ratio (T/NT), and to choose a better one to assess thyroid associated ophthalmopathy (TAO) activity.
 Methods: The clinical data were collected for 29 newly-diagnosed patients (58 eyes) with TAO who underwent orbital 99mTc-DTPA single photon emission computed tomography/computed tomography (SPECT/CT) fusion images according to the clinical activity score (CAS). They were divided into an active group (18 cases, 36 eyes), an inactive group (11 cases, 22 eyes), and a control group (9 cases, 18 eyes). Diagnostic value of orbital/occipital lobe radioactive uptake count ratio (T/NT1), orbital/occipital radioactive uptake count ratio (T/NT2), orbital/thalamus radioactive uptake count ratio (T/NT3), and orbital/cerebellar radioactivity uptake count ratio (T/NT4) were calculated, and the CAS of Spearman rank correlation and receiver operating characteristic (ROC) curve were analyzed.
 Results: T/NT1, T/NT2 and CAS were correlated (r1=0.873, r2=0.527; P0.05). Area under the ROC curve of T/NT1 was 0.860, area under the ROC curve of T/NT2 was 0.581, and the accuracy for T/NT1 on TAO activity was good. T/NT1=9.74 could be used as active threshold for judge of TAO in patients.
 Conclusion: There is a good correlation between T/NT1 and CAS. TAO activity assessment possesses high diagnostic value, and SPECT/CT together with imaging anatomical location is more accurate.

Effects of positive expiratory pressure on pulmonary clearance of aerosolized technetium-99m-labeled diethylenetriaminepentaacetic acid in healthy individuals / Efeitos da pressão expiratória positiva na depuração pulmonar do ácido dietilenotriaminopentacético marcado com tecnécio-99m em aerossol em indivíduos saudáveis

ABSTRACT Objective: To evaluate the effects of positive expiratory pressure (PEP) on pulmonary epithelial membrane permeability in healthy subjects. Methods: We evaluated a cohort of 30 healthy subjects (15 males and 15 females) with a mean age of 28.3 ± 5.4 years, a mean FEV1/FVC ratio of 0.89 ± 0.14, and a mean FEV1 of 98.5 ± 13.1% of predicted. Subjects underwent technetium-99m-labeled diethylenetriaminepentaacetic acid (99mTc-DTPA) radioaerosol inhalation lung scintigraphy in two stages: during spontaneous breathing; and while breathing through a PEP mask at one of three PEP levels-10 cmH2O (n = 10), 15 cmH2O (n = 10), and 20 cmH2O (n = 10). The 99mTc-DTPA was nebulized for 3 min, and its clearance was recorded by scintigraphy over a 30-min period during spontaneous breathing and over a 30-min period during breathing through a PEP mask. Results: The pulmonary clearance of 99mTc-DTPA was significantly shorter when PEP was applied-at 10 cmH2O (p = 0.044), 15 cmH2O (p = 0.044), and 20 cmH2O (p = 0.004)-in comparison with that observed during spontaneous breathing. Conclusions: Our findings indicate that PEP, at the levels tested, is able to induce an increase in pulmonary epithelial membrane permeability and lung volume in healthy subjects.

RESUMO Objetivo: Avaliar os efeitos da pressão expiratória positiva (PEP) na permeabilidade da membrana epitelial pulmonar em indivíduos saudáveis. Métodos: Foi avaliada uma coorte de 30 indivíduos saudáveis (15 homens e 15 mulheres), com média de idade de 28,3 ± 5,4 anos, média da relação VEF1/CVF de 0,89 ± 0,14 e média de VEF1 de 98,5 ± 13,1% do previsto. Os indivíduos foram submetidos a cintilografia pulmonar por inalação de radioaerossol de ácido dietilenotriaminopentacético marcado com tecnécio-99m (99mTc-DTPA em inglês) em dois estágios: durante respiração espontânea e durante respiração com uma máscara de PEP de 10 cmH2O (n = 10), 15 cmH2O (n = 10) ou 20 cmH2O (n = 10). O 99mTc-DTPA foi nebulizado por 3 min, e sua depuração foi registrada por cintilografia por um período de 30 min durante respiração espontânea e por um período de 30 min durante a respiração com uma máscara de PEP. Resultados: A depuração pulmonar do 99mTc-DTPA foi significativamente menor quando PEP foi aplicada a 10 cmH2O (p = 0,044), 15 cmH2O (p = 0,044) e 20 cmH2O (p = 0,004), em comparação com a observada durante a respiração espontânea. Conclusões: Nossos achados indicam que o uso de PEP nos níveis testados pode induzir um aumento na permeabilidade da membrana epitelial pulmonar e no volume pulmonar em indivíduos saudáveis.

Comparison of Renal Function between Robot-Assisted and Open Partial Nephrectomy as Determined by Tc 99m-DTPA Renal Scintigraphy

We compared postoperative renal function impairment between patients undergoing robot-assisted partial nephrectomy (RAPN) and those undergoing open partial nephrectomy (OPN) by using Tc-99m diethylenetriaminepentaacetic acid (DTPA) renal scintigraphy. Patients who underwent partial nephrectomy by a single surgeon between 2007 and 2013 were eligible and were matched by propensity score, based on age, tumor size, exophytic properties of tumor, and location relative to the polar lines. Of the 403 patients who underwent partial nephrectomy, 114 (28%) underwent RAPN and 289 (72%) underwent OPN. Mean follow-up duration was 35.2 months. Following propensity matching, there were no significant differences between the two groups in tumor exophytic properties (P = 0.818) or nephrometry score (P = 0.527). Renal ischemic time (24.4 minutes vs. 17.8 minutes, P < 0.001) was significantly longer in the RAPN group than in the OPN group, while the other characteristics were similar. Multivariate analysis showed that greater preoperative renal unit function (P = 0.011) and nephrometry score (P = 0.041) were independently correlated with a reduction in glomerular filtration rate. The operative method did not correlate with renal function impairment (P = 0.704). Postoperative renal function impairment was similar between patients who underwent OPN and those who underwent RAPN, despite RAPN having a longer ischemic time.

Application of plasma clearance of iohexol in evaluating renal function in chinese children with chronic kidney disease / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the accuracy of plasma clearance of iohexol (PCio) for glomerular filtration rate (GFR) measurement in Chinese children with chronic kidney disease (CKD) and assess the feasibility of single-blood-sample method or dried capillary blood spots in determining the PCio.</p><p><b>METHODS</b>Totally 45 CKD children were included,in whom the (99m) Technetium-diethylenetriaminepentaacetic acid ((99m)Tc-DTPA) plasma clearance and iohexol plasma clearance were simultaneously determined. Blood samples were obtained 2,4,and 5 hours after injection. In addition, we also evaluated the efficacy of single blood sample method and dried blood spots method in iohexol plasma clearance.</p><p><b>RESULTS</b>Forty-five CKD children completed the iohexol plasma clearance and thirty-six children completed the (99m)Tc-DTPA plasma clearance at the same time among them. Thirteen children finished the iohexol dried blood spot clearance. The correlation coefficient between (99m)Tc-DTPA plasma clearance and iohexol plasma clearance was 0.941 and the bias was (6.53 ± 11.6) ml/ (min·1.73 m²), and the intraclass correlation coefficient (ICC) was high (ICC=0.947). The correlation between iohexol single-sample plasma clearance and double samples was also strong (r=0.958), with the bias being (4.26 ± 9.06)ml/(min·1.73 m²) and the ICC being 0.970. The iohexol clearance by dried blood spots showed a good correlation with the serum iohexol clearance (r=0.950), with the bias still being small [(0.48 ± 10.89)ml/(min·1.73 m²)].</p><p><b>CONCLUSIONS</b>Iohexol plasma clearance has satisfactory agreement with (99m)Tc-DTPA plasma clearance and can be used as an ideal method to measure GFR in CKD children. The single-sample method and dried blood spots method make iohexol plasma clearance more convenient and practical.</p>

comparison between estimates of glomerular filtration rate using technetium-99m-diethylene-triamine-pentaacetic acid clearance and modification of diet in renal disease equation

Background: More than half of cancer patients have unrecognized renal insufficiency, which is a reduced glomerular filtration rate [GFR] and is a disease complication factor

Aims and Objectives: The objective of the present study is to compare the accuracy of GFR with two methods, i.e., GFR by Gates' method [gamma camera uptake method with technetium-99m-diethylene-triamine-pentaacetic acid [Tc-99m-DTPA] and GFR by modification of diet in renal disease [MDRD] equation in cancer patients

Materials and Methods: A total of 50 cancer patients with abnormal serum creatinine were included in the study. 50 age matched cancer patients with normal creatinine, blood urea nitrogen [BUN] and serum albumin were taken as controls. History of patients including site of cancer, chemotherapy regime and dose of chemotherapy was recorded. Serum creatinine was estimated by auto analyzer using Jaffe's method. Glomerular filtration rate [GFR] was calculated using camera based modified gates method with [99mTc-DPTA] and MDRD equation

Results: Mean age of patients was 50 year. Level of serum creatinine and BUN were significantly increased [P < 0.001] in patients when compared to controls. Level of serum albumin was non-significantly [P > 0.05] decreased in cancer patients and body surface area also increased, but differences were non-significant [P > 0.05] in cancer patients when compared to controls. Mean GFR was estimated by camera based modified gates method which increased in cancer patients as compared to GFR by MDRD equation but differences were not significant [P > 0.05]. Cost, time duration and time for reagent preparation was very high using Renogram [Gate's method] as compared to the cost and other factors involved in estimation of GFR by MDRD equation

Conclusions: It is concluded that the MDRD equation is more suitable, economical and time saving for the estimation of GFR as compared to Renogram using Tc-99m-DPTA. However future prospective studies are required to the estimation of GFR in those tumors, which may cause kidney damage such as cisplatin or carboplatin, methotrexate

Assessment of hepatic reserve function of cirrhosis liver using dynamic SPECT (99m)Tc-galactosyl human serum albumin scintigraphy / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the effectiveness of dynamic SPECT (99m)Tc-galactosyl human serum albumin (GSA) scintigraphy on the assessment of reserve function of cirrhosis liver.</p><p><b>METHODS</b>From January 2010 to December 2011, 55 patients with cirrhosis liver were enrolled in this study. The case numbers of male and female were 43 and 12 respectively and the age was (51 ± 9) years (ranging from 35 to 69 years). After routine biochemistry test, CT scan and (99m)Tc-GSA dynamic SPECT scan were performed in turn using a juxtaposed SPECT/CT system. Then the morphologic volume of liver parenchyma (MLV), functional liver volume (FLV) and the hepatic cell absorption rate constant (GSA-K) were calculated. The correlations between GSA-K and routine biochemistry test, Child-Pugh score, indocyanine green clearance rate (ICG-K) were analyzed. The patients were further divided into 3 groups according to whether there was occlusion or stenosis in the main branch of left portal vein (group 1, n = 5), right portal vein (group 2, n = 13) or not (group 3, n = 37) and the regional hepatic functions index of the 3 groups were compared.</p><p><b>RESULTS</b>The value of FLV of the whole, left and right liver was (594 ± 152) ml, (244 ± 119) ml and (356 ± 171) ml, respectively. There were correlations between GSA-K and total bilirubin, prothrombintime, Child-Pugh score and ICG-K (r = -0.730--0.298, P < 0.05). The FLV and MLV ratios of involved hemiliver to uninvolved hemiliver were 0.09 ± 0.06 and 0.30 ± 0.14 in group 1, 0.57 ± 0.43 and 1.08 ± 0.63 in group 2, 0.71 ± 0.30 and 0.71 ± 0.48 in group 3. The difference in MLV-FLV ratio was signifcant between group 1 and group 3, between group 2 and group 3 (P = 0.000).</p><p><b>CONCLUSIONS</b>The dynamic SPCECT (99m)Tc-GSA scintigraphy can not only assess the whole liver function of cirrhosis liver effectively, but also evaluate the variation of regional liver function accurately.</p>

Research of the glomerular filtration rate estimation model / 生物医学工程学杂志

The glomerular filtration rate (GFR) is an important index of renal function with advantages of accurate, sensitive, stable, repetitive and accurate measurement of renal functions. The GFR is mainly determined in the clear rate of radioisotope markers (99m)Tc-DTPA, the process of which is complicated, long time-taking, high cost, and radioactively injuring. Recently, the methods using other renal function parameters measured easily to create the mathematic models and to estimate GFR are being investigated in the world. In this paper, for the renal function data of the Chinese, the efficiency in the three existing GFR formulas has been optimized with multi-function optimization techniques and the accuracy of the computation has been improved. Then the BP neural network technology is used for establishing a new GFR formula, which is a simpler form and obtains higher precision result than the formulas existed. The rmse and P30 of the new formula are better than those of the old ones.

Serum cystatin-C is not superior to serum creatinine in predicting glomerular filtration rate in cirrhotic patients

Assessment of glomerular filtration rate [GFR] by common creatinine-based methods is potentially inaccurate in patients with cirrhosis. Cirrhotic patients have several underlying conditions that contribute to falsely low serum creatinine concentrations, even in the presence of moderate to severe renal impairment. Therefore creatinine-based methods usually overestimate true GFR in these patients. Cystatin-C is a low molecular weight protein and an endogenous marker of GFR. We compared the accuracy of plasma cystatin-C and creatinine in assessing renal function in cirrhotic patients. We serially enrolled cirrhotic patients with stable renal function admitted in our ward if they met the inclusion criteria and consented to participate. Child-Pugh [CP] score was calculated for all patients. GFR was calculated using serum creatinine, serum cystatin-C, and 99m TC-DTPA clearance with the last one serving as the gold standard. The area under curve [AUC] on receiver-operating characteristic curves [ROC] were used to assess the diagnostic accuracy of each calculated GFR with that measured by DTPA. Fourty-eight patients were enrolled [32 males, 66.7%]. Nine were in class-A, 20 in class-B and 19 in class-C of CP. Cystatin-C did not perform well in predicting the true GFR, while serum creatinine performed relatively accurately at GFR<80ml/min [AUC=0.764, p=0.004]. Serum creatinine at a cutoff of 1.4 mg/ dl was 20% sensitive and 92% specific and with at a cutoff of 0.9 mg/dl was 77% sensitive and 72% specific for diagnosis of impaired renal function. Cystatin-C could not predict GFR effectively even after stratification for CP score, gender, and BMI. Serum creatinine could predict GFR<65ml/min in females [ROC curve AUC=0.844,p=0.045]. In those with BMI>20 kg/m2 a GFR<80 ml/min could also be predicted by serum creatinine [ROC curve AUC=0.739,p=0.034]. It also could predict GFR<80ml/min in patients with CP class A and B [ROC curve AUC=0.795,/7=0.01], but not in patients with CP class C. Neither serum creatinine nor Cystatin-C are good predictors of GFR in cirrhotic patients, although serum creatinine seems to perform better in selected subgroups

Tc-99m diethylenetriamine pentaacetic acid [DTPA]: is it reliable for assessment of methotrexate-induced cumulative effect on renal filtration in rheumatoid arthritis patients?

Methotrexate [MTX] is commonly employed as the initial DMARD used for treatment of Rheumatoid arthritis [RA]. We aimed to contribute to the safety profile of MTX by assessing its cumulative effect on renal filtration. Fifty two RA adult females with normal base-line serum creatinine and GFR at the initial diagnosis of the disease were included. Group-1 [G1] included 30 patients [mean age 40.4 +/- 4.4 years] on MTX and NSAIDS, while 22 RA patients [mean age 38.5 +/- 8.2 years] who received NSAIDs only served as the control group [G2]. Renal function was assessed by GFR-measurement using Technetium diethylenetriamine-pentaacetic acid [Tc-99 m-DTPA] at the point of the study time corresponding to disease duration. 21/30 [70%] in G1 showed reduced GFR compared to 6/22 [27.3%] in G2 [P0.007] with 3.3 +/- 0.5% annual reduction of GFR. Reduced GFR in G1 showed significant negative correlation with age [r = -0.396, P = 0.005], MTX-cumulative dose [r = -0.263, P = 0.049], MTX-intake duration [r = -0.293, P = 0.031] and NSAID-intake duration [r = -0.344, P = 0.014]. Low dose MTX has a slow cumulative effect on renal filtration manifested by GFR reduction over time that could be monitored by Tc-99 m DTPA

Validation of modified estimated glomerular filtration rate in chronic kidney disease patients

To derive the ethnic factor and validate the modified estimated Glomerular Filtration Rate [eGFR] by Modification of Diet in Renal Disease [MDRD] equation for Chronic Kidney Disease [CKD] patients of Rawalpindi. Cross- sectional study. Armed Forces Institute of Pathology [AFIP], Rawalpindi, from July 2011 to July 2012. A total of 140 patients with CKD reporting to AFIP for GFR measurement by [99m] Technetium diethylenethiaminepenta-acetic acid [[99m]Tc-DTPA] renal scan were consecutively inducted. Serum creatinine was measured by the Jaffe's assay on Beckman DxC 600 Analyzer prior to the renal scan. Ethnic factor for population of Rawalpindi with CKD was derived for the MDRD eGFR equation using [99m]Tc-DTPA renal scan by Gates method as the reference method. MDRD equation was modified by inclusion of the ethnic factor in it. Agreement between the reference GFR [rGFR] and the modified MDRD eGFR [mGFR] was assessed by applying paired samples t-test. Out of 140 patients of CKD, 99 [71%] were males and 41 [29%] females, with mean age of 55 +/- 13.42 years. The mean values were 32.91 +/- 14.96, 34.89 +/- 16.45, 0.971 +/- 0.20 and 33.87 +/- 15.97 for rGFR, original eGFR, ethnic factor and mGFR respectively. The mGFR with new ethnic factor of 0.971 showed improved performance as compared to original eGFR and showed a significant level of correlation with rGFR [r[2] = 0.817], at a p-value of 0.000. This study validates the mGFR equation by inclusion of newly derived ethnic factor of 0.971 in the population of Rawalpindi with CKD and it was found to be not significantly different from the rGFR.

Correlation of renal AQP1-4 protein expression with renal parenchyma thickness and glomerular filtration rate in children with congenital hydronephrosis / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the relationship of renal aquaporin -1, -2, -3, and -4 (AQP1-4) expression with renal parenchymal thickness and glomerular filtration rate (GFR) in children with congenital hydronephrotis.</p><p><b>METHODS</b>Renal tissue samples were obtained from 10 kidneys of 10 children (age: 62.3±18.3 months) with hydronephrosis and who underwent Anderson-Hynes pyeloplasty. Renal control samples were obtained from 6 children (age: 62.7±17.1 months) undergoing nephrectomy for nephroblastoma and were confirmed histologically as normal renal tissues. Renal parenchymal thickness of the hydronephrotic kidneys was measured by ultrasound preoperatively and was verified at operation. Renal GFR was assessed using 99mTc-DTPA scintigraphy preoperatively. Western blot was used to examine the expression of AQP1-4 in the renal tissues. The correlations of renal AQP1-4 expression with the renal parenchymal thickness and GFR were assessed by Pearson correlation analysis.</p><p><b>RESULTS</b>The expression of AQP1-4 in the hydronephrotis group was markedly reduced compared to that in the control group (P<0.05). The mean renal parenchymal thickness of the hydronephrotic kidney was 4.59±2.25 mm measured by ultrasound preoperatively. The mean GFR of the obstructed kidney was significantly lower than that of the contralateral kidney in the hydronephrosis group (40±12 mL/min vs 105±20 mL/min; P<0.05). The expression of AQP1, 2, 3 and 4 was positively correlated with preoperative renal GFR and renal parenchymal thickness in the hydronephrosis group (P<0.05). Renal parenchymal thickness was positively correlated with renal GFR (P<0.05).</p><p><b>CONCLUSIONS</b>The expression of renal AQP1-4 is reduced in children with congenital hydronephrosis. The expression levels of AQP1-4 are positively correlated with renal parenchymal thickness and GFR.</p>

Serum cystatin C level is a useful marker for the evaluation of renal function in patients with cirrhotic ascites and normal serum creatinine levels / 대한간학회지

BACKGROUND/AIMS: Several studies suggested that serum cystatin C (CysC) is more useful than serum creatinine (Cr) for the assessment of renal function in patients with liver cirrhosis. This study evaluated the clinical significance of CysC in patients with cirrhotic ascites and normal Cr level. METHODS: We enrolled patients with cirrhotic ascites and a normal serum Cr level (<1.2 mg/dL). GFR was measured by 99mTc-DTPA renal scan. Serum Cr, CysC, and Cr clearance (CCr) were measured on the same day. Significant renal impairment and severe renal impairment were defined as GFR <60 mL/min and GFR <30 mL/min, respectively. RESULTS: Eighty-nine patients with cirrhotic ascites were enrolled in the study (63 men and 26 women; age, 55+/-11 years). Forty-seven (52.8%) and 42 (47.2%) patients were in Child-Pugh grade B and C, respectively. Serum Cr and CysC levels and GFR were 0.8+/-0.2 mg/dL, 1.1+/-0.3 mg/L, and 73.4+/-25.5 mL/min, respectively. Significant and severe renal impairment were noted in 28 (31.5%) and 2 (2.2%) patients, respectively. GFR was well correlated with serum Cr, CysC, and e-GFRMDRD, while it was not correlated with e-GFRC&G. In multivariate analysis, only CysC was significantly correlated with GFR (beta, 45.620; 95% CI, 23.042-68.198; P<0.001). Serum CysC level was the only independent predictor for significant renal impairment. CONCLUSIONS: Significant renal dysfunction was not rare in patients with cirrhotic ascites, even their serum Cr level is normal. Serum CysC is a useful marker for detecting significant renal dysfunction in these patients.

Estimation of glomerular filtration rate as a predictor of renal impairment in egyptian systemic sclerosis patients, a comparative study between the classic gates method using TC99M DTPA and the cockcroft and gault formula: correlation with disease severity

Prognosis of Systemic sclerosis largely depends on involvement of internal organs. Kidney affection has the worst prognosis and highest mortality rate. Aim was to evaluate renal impairment in patients with systemic sclerosis by measuring the Glomerular filtration rate and then calculating the GFR using the Cockcroft and Gault formula and the Modification of Diet in Renal Disease equation [MDRD] formula and test the accuracy of these formulae. The study included 31 scleroderma patients [27 females, 4 males] recruited from the Rheumatology and Rehabilitation Department, Cairo University hospitals, mean age 43.25 +/- 11.28 years, 16 had limited systemic sclerosis, 12 diffuse systemic sclerosis and 3 had overlap syndrome. Therty-one age and sex matched healthy controls were included. Estimation of disease severity was done using disease severity index. GFR was measured using TC99mDTPA. The modified Cockcroft and Gault formula and equation 7 from the Modification of Diet in Renal Disease [MDRD] were used. A measured GFR within normal [>89ml/min] was found in 14 patients [45.1%] with normal kidney function and serum creatinine. Reduced GFR was reported in 17 patients [54.9%], it ranged from 60-89ml/min with mild renal impairment in 10 patients [32.3%], and ranged from 30-59ml/min showing moderate functional impairment in 7 patients [22.6%], none of our patients had severe renal impairment according to the Gates method for measuring the GFR. The formulae used succeeded to detect reduction of GFR in 35.29% of those affected using the Cockcroft-Gault and in 41.17% of those affected using the MDRD. A positive correlation was found between MDRD and measured GFR, furthermore, the decline in the GFR didn't show any correlation with disease severity. A positive correlation was also reported between the presence of renal involvement and pulmonary vascular involvement in the group under study p=0.04. Measurement of the GFR using Gates method showed reduction of the GFR in 54.9% of the SSc patients under study. Serum creatinine was an insensitive tool for evaluating renal functional impairment. The formulae used weren't as precise as the measured GFR in diagnosing all cases with subclinical renal involvement in the studied population. Patients with systemic sclerosis should be screened for renal involvement irrespective of disease severity or duration

Application of technetium galactosyl human serum albumin diethylenetriamine pentaacetic acid injection on liver imaging in mouse models with different hepatic injuries / 中国医学科学院学报

<p><b>OBJECTIVE</b>To identify the uptake and biological distribution of technetium galactosyl human serum albumin diethylenetriamine pentaacetic acid injection (99mTc-GSA) in three mouse models with different degrees of hepatic injuries.</p><p><b>METHODS</b>Three mouse models including hepatic fibrosis, hepatic cholestasis, and liver cancer were established. Hepatic fibrosis model was established by intraperitoneal injection of carbon tetrachloride, 0.4 ml 10%, every 48 hours for 48 days. Hepatic cholestasis model was set up by ligature of the common bile duct for 72 hours, and liver cancer model by implantation of H22 tumor cells underneath liver capsule for 10 days. On measurement, each mouse in different models and normal controls was injected with 0.1 ml (0.37 MBq)99mTc-GSA (2 microg) into vena caudalis, and 5 minutes later sacrificed by decapitation. Important organs and tissues including liver, heart, lungs, kidney, spleen, stomach, blood, bones, muscles, and intestines were taken and their different radio countings were measured. The hepatic injuries were evaluated with serum and pathological examinations.</p><p><b>RESULTS</b>99mTc-GSA was concentrated in the liver in all three models and the control mice ( >40% ID x g(-1)). Compared with the control mice (90.05 +/- 10.55)% ID x g(-1), the density of 99mTc-GSA was significantly lower in the models with hepatic injuries (P < 0.001). The liver function test indicated that the injury in hepatic fibrosis model was less serious than those in the other two models. However, the concentration of 99mTc-GSA in hepatic fibrosis model [(72.20 +/- 2.13)% ID x g(-1)] was significantly higher than those in the models with cholestasis [(56.72 +/- 5.92)% ID x g(-1)] and liver cancer [(42.80 +/- 6.05)% ID x g(-1)] (P < 0.001).</p><p><b>CONCLUSIONS</b>99mTc-GSA may well concentrate in liver and its concentration degree is adversely correlated with hepatic injuries. Therefore 99mTc-GSA may be clinically used as liver imaging agent. When combined with three-dimensional scanning technique, it may facilitate constructing a new three-dimensional imaging method to demonstrate the function of designed liver segments.</p>

Split renal function in young children with unilateral pelvi-ureteric junction obstruction using [99m]Tc-DTPA or [99m]Tc-MAG[3]

Cases of unilateral hydronephrosis in pediatric patients are mostly due to pelvi-ureteric junction obstruction [PUJO] that causes hindrance in the drainage of urine outflow, leading to kidney function impairment The impaired excretory drainage is expected to have diminished or normal split renal function [SRF] on the affected side. However, in a significant number of patients with severe PUJO an elevated SRF can be found. The aim of this work was to estimate the frequency of various grades of SRF in children with PUJO. Secondly, to find out whether there is a difference between [99m]Tc-DTPA or[99m]Tc-MAG3 in assessing the SRF in these children. Fifty-eight children with unilateral PUJO referred for dynamic renography were included in this study on retrospective basis. Twenty-four patients underwent dynamic renography using [99m]Tc-DTPA while 34 were evaluated using [99m]Tc-MAG3. For both [99m]Tc-DTPA and [99m]Tc-MAG3, the dynamic renography started by perfusion phase [1 frame/ sec for 1 min] followed by 15-sec frames for 29 minutes. In all patients frusemide was given at a dose of 1mg/kg at 10 minutes post injection, In the DTPA and MAG3 studies, glomerular filtration rate [GFR] and renal plasma flow [ERPF] were estimated respectively and SRF was calculated from both figures. The normal range for SRF was considered 45% to 55%, In all patients, diagnostic ultrasound was done prior to isotopic renography. The mean age of the studied children was 18 +/- 10 months. The children in the DTPA and MAG3 groups were age and sex-matched. In the DTPA group 25% of the patients had a diminished SRF [< 45%], [46%] had normal SRF and 29% showed paradoxical SRF [> 55%]. In the MAG3 group, 32% of patients had diminished SRF, 41% had normal SRF and 26% showed paradoxical SRF of > 55%. There was no significant difference between DTPA and MAG3 in estimation of SRF in those with normal and suprnormal SRF [P value = 0.0865 and 0,094 respectively] however MGA3 tends to be superior to DTPA in cases of impaired renal function [P value < 0.05. The obstructive renogram patterns define the functional significance of the various grades of hydronephrosis detected by ultrasound. Both [99m]Tc-MAG3 and [99m]Tc-DTPA are comparable and can estimate the SRF in young children with unilateral PUJO, however, in cases of impaired renal function [99m]Tc-MAG3 tends to be better than [99m]Tc-DTPA. Impaired and Paradoxical supranormal split renal function are significantly present in young children with unilateral PUJO

Clinical follow-up of children with low differential function on diuretic renogram.

OBJECTIVE: One of the most challenging dilemmas in pediatric urology today is to determine the optimal management of children with hydronephrotic kidney secondary to suspected ureteropelvic junction obstruction. Some believe in early surgical management while others believe in conservative management. To better define these issues, the authors retrospectively reviewed 101 patients with hydronephrosis. MATERIAL AND METHOD: The present study was approved by The Children 's Hospital of Philadelphia 's institutional review board and waiver of informed consent for retrospective study. One hundred and one children (72 males and 29 females) of ages of 6 days to 19 years with hydronephrosis with suspected UPJ obstruction underwent diuretic renograms with 99mTc DTPA. The authors classified the differential renal function into three groups: Group I: 0-15%, Group II: 16-30%, and Group III: 31-46%. RESULTS: Forty-one patients with conservative management, 32% (5 in group I: 1 in group II and 7 in group III) showed improved differential renal function. Non-operative management patients from group I and II showed no deteriorating renal function and only one case from group III had deteriorating renal function. In operative management, 78% of group I, 41% of group II, and 25% of group III showed improvement in differential renal function. In the remaining operative cases, six showed deteriorated differential renal function [1 (4%) group I: 3 (18%) group II: 2 (10%) group III] whereas 24 remained stable or unchanged [Group 1: 4 (17%), Group II: 7 (41%), Group 111: 13 (65%)]. CONCLUSION: The authors recommended conservative management for children with differential renal function between 16-46%.

Unusual dialysate leakage complicating peritoneal dialysis

A 16-year-old female who had end-stage renal disease on 2-month continuous ambulatory peritoneal dialysis (CAPD) presented with perineal pain 4 days before admission. The physical examination revealed bilateral labial edema. Peritoneal scintigraphy was requested after infusing 2 L peritoneal dialysate with direct administration of 370 MBq (10mCi) technetium-99m diethylenetriamine pentra-acetic acid into peritoneal cavity via Tenckhoff catheter. Radioactive uptake from right inguinal to labial region was clearly demonstrated, and this indicated the site of peritoneal leakage. After surgical intervention unilaterally, she continued CAPD without any recurrence.