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Regional Intrarenal Perfusion in Man: An Assessment with the Scintillation Camera

Harvard Medical School and Peter Bent Brigham Hospital, Boston, Massachusetts

Correspondence: For reprints contact: Norman K. Hollenberg, Dept. of Radiology, Peter Bent Brigham Hospital, 721 Huntington Ave., Boston, Mass. 02115.

ABSTRACT

The importance of intrarenal perfusion patterns in a number of physiologic and pathophysiologic states has led to increasing interest in radioxenon for assessing this parameter in man. In this study the scintillation camera has been used to evaluate concentric and segmental xenon turnover in normal man and in patients with hypertension and acute oliguric renal failure. In healthy kidneys the area of the image defined by the isotope decreased approximately 20% in the first minute after injection, a finding compatible with a cortical flow rate greater than that in the remainder of the kidney. Intrarenal flow rates defined with the camera were identical to those measured with a probe-mounted detector; however, recirculation did contribute to probe-recorded tail components.

In patients with oliguric renal failure, the study confirmed the absence of a rapid flow component. Failure of the size of the renal image to decrease, as it does normally, strongly supports the hypothesis of a preferential reduction in cortical perfusion. Washout of isotope from the superior and inferior renal poles was relatively homogeneous in normal man; however, there were quantitatively significant differences in segmental washout in patients with nephrosclerosis or chronic pyelonephritis.

These studies provide strong support for current concepts of normal renal perfusion in which the rapid component of xenon washout represents cortical perfusion; they also confirm a model of acute renal failure in which there is a preferential reduction in cortical perfusion; and they suggest the presence of segmental renal perfusion abnormalities in patients with essential hypertension.