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The Exercise Renogram and Its Interpretation

German Cancer Research Center, Heidelberg; Division of Vascular Surgery, University of Heidelberg, Germany

Correspondence: For correspondence or reprints contact: John H. Clorius, MD, Department of Oncological Diagnostics and Therapy, German Cancer Research Center, Im Neuenheimer Feld 280 FRG-69120 Heidelberg, Germany.

ABSTRACT

The exercise renogram is a rarely used diagnostic procedure, but it may visualize an exercise-induced change in renal function related to the pathophysiology of essential hypertension, which could greatly increase interest in this examination. The aim of this study was to demonstrate the interpretative approach and the terminology which is used to describe results of exercise renography, using a population of hypertensives with renovascular disease. Methods: We reviewed the examinations of 70 hypertensives who had supine renography as well as exercise renography with a 60–80 W work load. Forty-eight patients were examined with ^99mTc-MAG3 and 22 with ¹³¹I hippurate. The renographic and angiography results were recorded as well as the antihypertensive drugs used and the site of vascular lesions. Results: Thirty-three hypertensives developed a bilateral-abnormal exercise renogram, which appears to be associated with primary hypertension. Eight individuals responded to exercise with a unilateral-abnormal exercise renogram, in a kidney behind a stenosis. Only 19 patients had a normal exercise renogram, and 10 had only one functioning kidney. Pathology recognized but unrelated to the intervention included nonfunctioning and small kidneys and pelvic retention. Conclusion: Exercise renography's only indication is for recognition of pathology unique to hypertension, since other function disturbances were recognized in resting renograms.

Key Words: renography • technetium-99m-MAG3 • hypertension • indium-111-DTPA • exercise