Report of the Radionuclides in Nephrourology Committee for evaluation of transplanted kidney (review of techniques)
| Autor: | Andrew Taylor, Tawatchai Chaiwatanarat, George N. Sfakianakis, Angelika Bischof-Delaloye, Eva V. Dubovsky, Michael Rutland, Andrew J.W. Hilson, Hong Yoe Oei, Charles D. Russell, B. Bubeck |
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| Přispěvatelé: | Radiology & Nuclear Medicine |
| Rok vydání: | 1999 |
| Předmět: |
Graft Rejection
medicine.medical_specialty Urology Renal function Angiotensin-Converting Enzyme Inhibitors Renal artery stenosis Kidney Postoperative Complications Image Interpretation Computer-Assisted medicine Image Processing Computer-Assisted Humans Radiology Nuclear Medicine and imaging Diuretics Acute tubular necrosis Kidney transplantation medicine.diagnostic_test business.industry Radioisotope renography Effective renal plasma flow Kidney Tubular Necrosis Acute medicine.disease Fibrosis Kidney Transplantation Renal Plasma Flow Effective medicine.anatomical_structure Technetium Tc 99m Pentetate Nuclear medicine business Radioisotope Renography Kidney disease Follow-Up Studies |
| Zdroj: | Seminars in Nuclear Medicine, XXIX(2), 175-188. W.B. Saunders |
| ISSN: | 0001-2998 |
| Popis: | 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 99m Tc mercaptoacetyltriglycine, or 99m Tc diethylenetriamine-pentaacetate (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. |
| Databáze: | OpenAIRE |
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