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Renal Handling of Technetium-99m DMSA: Evidence for Glomerular Filtration and Peritubular Uptake

Departments of Nuclear Medicine, Pediatrics, and Internal Medicine, University Hospital, Groningen, The Netherlands

Correspondence: For reprints contact: M. J. de Lange, Dept. of Nuclear Medicine, University Hospital, 59 Oostersingel, 9713 EZ Groningen, The Netherlands.

ABSTRACT

The finding of an enhanced excretion of [^99mTc]dimercaptosuccinic acid (DMSA) in patients with tubular reabsorption disorders prompted us to investigate the role of filtration in the renal handling of [^99mTc]DMSA. Our studies in human serum indicated that binding to serum proteins was 90%. Chromatography of human urine and studies in rats showed that the complex was excreted unaltered into the urine. Renal extraction of [^99mTc]DMSA in a human volunteer was 5.8%. Continuous infusion of [^99mTc]DMSA in 13 individuals with normal renal function gave the following results (mean ± s.d.): plasma clearance of [^99mTc]DMSA 34 ± 4 ml/min, urinary clearance of [^99mTc]DMSA 12 ± 3 ml/min. The calculated filtered load of [^99mTc]DMSA closely resembled the urinary clearance, whereas the plasma clearance was about three times faster. This indicates that peritubular uptake accounts for 65% and filtration for 35% of the renal handling of [^99mTc]DMSA.

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