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Kidney Function After Radical Nephrectomy: Assessment by Quantitative SPECT of ^99mTc-DMSA Uptake by the Kidneys

Departments of Nuclear Medicine and Urology, Carmel Medical Center and Bnai Zion Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

Correspondence: For correspondence or reprints contact: Simona Ben-Haim, MD, DSc, Department of Nuclear Medicine, Carmel Medical Center, Haifa, Israel 34362.

ABSTRACT

To determine the function of the remaining contralateral kidney after the removal of a functioning kidney, 30 consecutive patients (18 men, 12 women; average age, 67 y; age range, 34–67 y) who were undergoing unilateral radical nephrectomy were evaluated by sequential quantitative ^99mTc-dimercaptosuccinic acid (DMSA) SPECT (QDMSA) studies. Methods: The 30 patients were undergoing radical nephrectomy for renal tumors. The first study was done before surgery. Follow-up studies were performed 2–23 mo after surgery. Clinical evaluations and determinations of serum creatinine level were performed at the same time as the QDMSA studies. Results: The relative contribution of the resected kidneys to the global renal function before surgery was 43.2% ± 7.3%. After surgery the uptake of the remaining kidney increased from 13.4% ± 4.0% to 18.3% ± 5.8% (t = 5.7; P = 0.0000). The relative function of the remaining kidney increased from 56.8% ± 7.1% to 79.1% ± 23.6% (t = 4.9; P < 0.0001) of the global renal function before nephrectomy. Increases in the renal volume (from 211 ±62 cm³ to 229 ± 68 cm³; t = 4.5; P = 0.0001) and in the percentage injected dose per cubic centimeter (%ID/cm³) of the remaining kidney (from 0.066 ± 0.02 %ID/cm³to 0.085 ± 0.03 %ID/cm^3; t = 4.6; P = 0.0001) were associated with this change. Nine patients had 2 follow-up studies performed 3–4 mo after surgery and 12–14 mo after surgery. The volume of the remaining kidney (209.22 ± 46.20 cm³ versus 217.88 ± 58.85 cm³; t = 0.962; P = 0.364), the %ID/cm³ (0.09 ± 0.016 %ID/cm³ versus 0.093 ± 0.025 %ID/cm³; t = 0.362; P = 0.726), and the percentage uptake (19.26% ± 4.45% versus 20.11% ± 7.01%) did not change significantly between these 2 QDMSA studies. Conclusion: The results of this study suggest that adaptive changes causing hyperfunction of the remaining kidney may occur after nephrectomy of a functioning kidney in adults. These changes occur soon after surgery, persist for at least 1 y, and are evident on QDMSA studies.

Key Words: radionuclide imaging • quantitative SPECT • ^99mTc-DMSA • nephrectomy

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