Report of the radionuclides in nephrourology committee for evaluation of transplanted kidney (review of techniques)

E. V. Dubovsky, C. D. Russell, A. Bischof-Delaloye, B. Bubeck, T. Chaiwatanarat, A. J W Hilson, M. Rutland, Yoe Oei Hong Yoe Oei, George N Sfakianakis, Jr Taylor A.

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Comprehensive evaluation of renal transplants has been important in differential diagnosis of medical and surgical complications in the early post-transplantation period and in the long-term follow-up. If performed well, it yields excellent functional and good anatomic information about the graft that can be effectively used in the patient. That includes selection of patients for biopsy and for various drug regimens. This is true especially in patients with anuric acute tubular necrosis (ATN) and in patients with developing chronic rejection. Improving indices of renal function (effective renal plasma flow, uptake of tubular tracers) can indicate resolution of tubular injury (ATN) while there is still no improvement in plasma creatinine. In patients with chronic rejection, plasma creatinine increases only after approximately 30% of renal function is lost due to graft fibrosis. Early recognition of this condition could permit treatment and delay of retransplantation. The protocol recommended at the Copenhagen meeting includes a flow study, scintigram of the kidneys, prevoid and postvoid bladder image, injection site image (quality control), time/activity curves of the graft and bladder, and quantitative data of perfusion, function, and tracer transit. The flow study obtained during the initial transit of the bolus through the graft could be performed either with 99mTc mercaptoacetyltriglycine, or 99mTc diethylenetriaminepentaacetate (DTPA). Quantitative analysis of perfusion facilitates interpretation of the study during the early post-transplantation period. ATN, common in cadaver transplants, typically shows adequate perfusion. The function phase should include images and time/activity curves. Images alone are insufficient. Quantitative data such as clearance or other indices of function and indices of tracer transit are essential for correct interpretation of the results. Normal images and normal graft function reliably exclude clinically important complications. A single scintigram demonstrating prolonged tracer transit with decreased function cannot separate acute rejection and ATN. On serial studies, decline in function and poor perfusion are indicative of acute rejection. A normally appearing scintigram without cortical retention, but with low function, is consistent with chronic rejection. Pharmacological intervention to exclude obstruction (diuretic renogram) or hemodynamically significant renal artery stenosis (angiotensin converting enzyme challenge) should be used whenever indicated.

Original languageEnglish
Pages (from-to)175-188
Number of pages14
JournalSeminars in Nuclear Medicine
Volume29
Issue number2
StatePublished - May 5 1999
Externally publishedYes

Fingerprint

Radioisotopes
Transplants
Kidney
Necrosis
Perfusion
Creatinine
Urinary Bladder
Technetium Tc 99m Mertiatide
Transplantation
Effective Renal Plasma Flow
Renal Artery Obstruction
Peptidyl-Dipeptidase A
Cadaver
Diuretics
Quality Control
Patient Selection
Differential Diagnosis
Fibrosis
Pharmacology
Biopsy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Dubovsky, E. V., Russell, C. D., Bischof-Delaloye, A., Bubeck, B., Chaiwatanarat, T., Hilson, A. J. W., ... Taylor A., J. (1999). Report of the radionuclides in nephrourology committee for evaluation of transplanted kidney (review of techniques). Seminars in Nuclear Medicine, 29(2), 175-188.

Report of the radionuclides in nephrourology committee for evaluation of transplanted kidney (review of techniques). / Dubovsky, E. V.; Russell, C. D.; Bischof-Delaloye, A.; Bubeck, B.; Chaiwatanarat, T.; Hilson, A. J W; Rutland, M.; Hong Yoe Oei, Yoe Oei; Sfakianakis, George N; Taylor A., Jr.

In: Seminars in Nuclear Medicine, Vol. 29, No. 2, 05.05.1999, p. 175-188.

Research output: Contribution to journalArticle

Dubovsky, EV, Russell, CD, Bischof-Delaloye, A, Bubeck, B, Chaiwatanarat, T, Hilson, AJW, Rutland, M, Hong Yoe Oei, YO, Sfakianakis, GN & Taylor A., J 1999, 'Report of the radionuclides in nephrourology committee for evaluation of transplanted kidney (review of techniques)', Seminars in Nuclear Medicine, vol. 29, no. 2, pp. 175-188.
Dubovsky EV, Russell CD, Bischof-Delaloye A, Bubeck B, Chaiwatanarat T, Hilson AJW et al. Report of the radionuclides in nephrourology committee for evaluation of transplanted kidney (review of techniques). Seminars in Nuclear Medicine. 1999 May 5;29(2):175-188.
Dubovsky, E. V. ; Russell, C. D. ; Bischof-Delaloye, A. ; Bubeck, B. ; Chaiwatanarat, T. ; Hilson, A. J W ; Rutland, M. ; Hong Yoe Oei, Yoe Oei ; Sfakianakis, George N ; Taylor A., Jr. / Report of the radionuclides in nephrourology committee for evaluation of transplanted kidney (review of techniques). In: Seminars in Nuclear Medicine. 1999 ; Vol. 29, No. 2. pp. 175-188.
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