Renal Scintigraphy in the Acute Care Setting

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Renal scintigraphy is a powerful imaging method that provides both functional and anatomic information, which is particularly useful in the acute care setting. In our institution, for the past 2 decades, we have used a 25-minute renal diuretic protocol, technetium-99m (99mTc) mercaptoacetyltriglycine with simultaneous intravenous injection of furosemide, for all ages and indications, including both native and transplant kidneys. As such, this protocol has been widely used in the workup of acutely ill patients. In this setting, there are common clinical entities which affect patients with native and transplant kidneys. In adult patients with native kidneys one of the most frequent reasons for emergency room visits is renal colic due to urolithiasis. Although unenhanced computed tomography is useful to assess the anatomy in cases of renal colic, it does not provide functional information. Time zero furosemide renal scintigraphy can do both and we have shown that it can effectively stratify patients with renal colic. To this end, 4 characteristic patterns of scintirenography have been identified, standardized, and consistently applied: no obstruction, partial obstruction (mild vs high grade), complete obstruction, and stunned (postdecompressed) kidney. With the extensive use of this protocol over the past 2 decades, a pattern of “regional parenchymal dysfunction” indicative of acute pyelonephritis has also been delineated. This information has proved to be useful for patients presenting with urinary tract infection and suspected pyelonephritis, as well as for patients who were referred for workup of renal colic but were found to have acute pyelonephritis instead. In instances of abdominal trauma, renal scintigraphy is uniquely suited to identify urine leaks. This is also true in cases of suspected leak following renal transplant or from other iatrogenic/postsurgical causes. Patients presenting with acute renal failure can be evaluated with renal scintigraphy. A scintigraphic pattern of “relative preservation of flow as compared to function” has been identified as indicative of acute tubular necrosis, which is distinct from other potential causes of acute renal failure, such as nephrotoxicity and in the case of renal transplants, rejection.

Section snippets

Time-Zero Diuretic Renal Scintigraphy Protocol (MAG3-F0)

The MAG3-F0 protocol has been in use at our institution for the past 2 decades. It is an ideal protocol because it is safe, fast, easy, convenient for both the patient and the technologist, cost effective, reproducible, and can be used for all renal scintigraphy indications. Mercaptoacetyltriglycine (MAG3) is currently the most efficient radiopharmaceutical approved by the Food and Drug Administration for renal dynamic studies.1, 2 It is mainly a tubular agent with a high overall extraction

Colic

A significant number of emergency room (ER) visits are attributed to renal colic. In the United States, each year, over half a million people seek care in the ER and almost 3 million visits are made to healthcare providers for kidney stone problems.8 The economic impact is enormous, with an estimated $5 billion spent each year in the United States for hospitalizations, procedures to remove stones, and time lost from work.9 It is estimated that 13% of men and 7% of women will be diagnosed with a

Conclusion

In the current practice of medicine, there are many imaging choices for the workup of acutely ill patients. MAG3-F0 diuretic renography is a simple protocol that provides both functional and anatomic information with relatively low radiation dose to the patient. It can be used in adults and children, in native and transplant kidneys, and even in patients with compromised renal function. In this article, we have highlighted the possible applications of renal scintigraphy in the acute care

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