1. RENAL SCINTIGRAPHY Prepared and Presented by Paul Jolles, MD

2. Kidney Stone Anatomy Kidneys to Urinary Bladder ureterolithiasis

3. INDICATIONS DIFFERENTIAL FUNCTION GFR, ERPF OBSTRUCTION POST OPERATIVE EVALUATION NEED FOR FREQUENT FOLLOW-UP AZOTEMIA CONTRAST ALLERGY

4. HISTORICAL BACKGROUND CONTRAST UROGRAPHY FIRST CLINICALLY USEFUL UROGRAM 1929: DR. MOSES SWICK (U.S.)

5. IVP Phase I Initial injection Dynamic

6. IVP Phase II Cortical Transit

7. IVP Phase III Excretory

8. IVP Phase III Excretory

9. IVP Phase III Excretory

10. HISTORCAL BACKGROUND 1945: I-131 PRODUCTION (U.S.) 1947: COLTMAN AND MARSHALL (U.S.) KOLLMAN (GERMANY) SCINTLLATION COUNTER (PMT)

11. HISTORICAL BACKGROUND 1952: OESSER, BILLION (GER) COLLECTED URINE 1955: TAPLIN, WINTER (U.S.) FIRST RENOGRAM 1957: ANGER CAMERA (U.S.)

12. Renal Agents Contrast PAH HIPP Others

20. RADIOPHARMACEUTICALS TUBULAR SECRETION GLOMERULAR FILTRATION CORTICAL BINDING MIXED

21. TUBULAR SECRETION EFFECTIVE RENAL PLASMA FLOW I-131 ORTHIODOHIPPURATE Tc-99m MERCAPTOACEYTL- TRIGLYCINE (MAG3)

22. I-131 HIPPURAN 20% FILTERED 80% SECRETED DOSE: 300 uCi

25. Tc-99m MAG3 TUBULAR SECRETION 90% FILTRATION 10% DOSE: 5-10 mCi

26. Tc-99m MAG3 IMAGING FLOW (ARTERIAL) UPTAKE (NEPHROGRAM) EXCRETION (“CORTICAL TRANSIT”)

31. GLOMERULAR FILTRATION GLOMERULAR FILTRATION RATE Tc-99m DIETHYLENETRIAMINE PENTAACETIC ACID (DTPA) IODINATED CONTRAST Gd-DTPA

32. Tc-99m DTPA GLOMERULAR FILTRATION METAL CHELATOR 20% EXTRACTION FRACTION DOSE: 5-20 mCi

34. Tc-99m DTPA IMAGING FLOW (ARTERIAL) UPTAKE (NEPHROGRAM) EXCRETION (“CORTICAL TRANSIT”)

38. RENOVASCULAR HYPERTENSION ABRUPT ONSET HTN 55 YRS SEVERE/MALIGNANT HTN REFRACTORY HTN

39. RENOVASCULAR HYPERTENSION EPIGASTRIC BRUIT MOD HTN WITH VASCULAR DZ ACE INHIBITOR-INDUCED RF

40. RENOVASCULAR HYPERTENSION <1% HYPERTENSIVE PATIENTS ATHEROSCLEROSIS FIBROMUSCULAR DYSPLASIA RAS NOT NECESSARILY RVH

41. CAPTOPRIL RENOGRAPHY MEDICATION HISTORY DISCONTINUE ACE INHIBITORS SERUM CHEMISTRY (BUN/Cr)

42. CAPTOPRIL RENOGRAPHY ORAL AND IV HYDRATION BP MONITORING 25 MG CAPTOPRIL ORALLY 10 mCi MAG 3 AND LASIX

43. CAPTOPRIL RENOGRAPHY PHYSIOLOGY OF RVH DIMINISHED RBF RENIN-ANGIOTENSIN EFFERENT ARTERIOLE

45. CAPTOPRIL RENOGRAPHY PROLONGED TIME TO PEAK CORTICAL RETENTION >30% BASELINE STUDY

65. LASIX RENOGRAPHY EVALUATION FOR OBSTRUCTION LASIX WASHOUT HALF TIME

66. LASIX WASHOUT T1/2 TIME FOR CLEARANCE OF ½ ACTIVITY FROM THE KIDNEY AFTER LASIX

67. LASIX WASHOUT T1/2 NORMAL: <10-15 MIN OBSTRUCTED: >20 MIN

69. DILATED, NON-OBSTRUCTED PROGRESSIVE PELVOCALEAL TRACER ACCUMULATION PROMPT LASIX WASHOUT

79. DILATED, OBSTRUCTED PROGRESSIVE PELVOCALYCEAL TRACER ACCUMULATION IMPAIRED LASIX WASHOUT

83. IMPAIRED FUNCTION

84. RENAL FAILURE S/P AAA REPAIR Tc-99m MAG3 FLOW UPTAKE CORTICAL TRANSIT EXCRETORY PHASE

89. CORTICAL BINDING Tc-99m DIMERCAPTOSUCCINIC ACID (DMSA)

90. Tc-99m DMSA METAL CHELATOR 50% CORTICAL BINDING VIA SULFHYDRYL LINK (MAINLY PCT) 6% EXTRACTION FRACTION DOSE: 2-5 mCi

91. Tc-99m DMSA PYELONEPHRITIS RENAL MASS

96. MIXED Tc-99m GLUCOHEPTONATE

97. 12% CORTICAL BINDING (PCT) GLOMERULAR FILTRATION TUBULAR SECRETION DOSE: 10 mCi

102. GALLIUM SCINTIGRAPHY INTERSTITIAL NEPHRITIS ACUTE RENAL FAILURE ACUTE TUBULAR NECROSIS AMYLOIDOSIS VASCULITIS CHEMOTHERAPY

103. GALLIUM SCINTIGRAPHY BILATERAL MALIGNANCY LEUKEMIA, LYMPHOMA BILATERAL OBSTRUCTION NEPHROTIC SYNDROME PYELONEPHRITIS TUBERCULOSIS WEGENER’S GRANULOMATOSIS