Diuretic Renography in Hydronephrosis: Delayed Tissue Tracer Transit Accompanies Both Functional Decline and Tissue Reorganization
Andreas Schlotmann 1*,
John H. Clorius 2,
Wiltrud K. Rohrschneider 3,
Sandra N. Clorius 4,
Folker Amelung 2,
and
Kristianna Becker 5
1 Department of Nuclear Medicine, University Hospital Freiburg, Freiburg, Germany
2 German Cancer Research Center, Heidelberg, Germany
3 Department of Pediatric Radiology, Children's Hospital St. Anna Stift, Ludwigshafen, Germany
4 Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
5 Interfaculty Biomedical Research Institute, University of Heidelberg, Heidelberg, Germany
* To whom correspondence should be addressed. E-mail: Andreas.Schlotmann{at}Uniklinik-Freiburg.de.
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Abstract |
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The significance of delayed tissue tracer transit (TTT) of 99mTc-mercaptoacetyltriglycine (99mTc-MAG3) has not been systematically evaluated in hydronephrosis. We sought to demonstrate that delayed TTT accompanies both functional decline and histomorphologic restructuring. Methods: Twenty 2- to 3-mo-old piglets with surgically induced partial unilateral ureteral stenosis were examined with magnetic resonance urography (MRU) to evaluate morphology and with 99mTc-MAG3 diuretic renography (DR) to determine single-kidney function (SKF), evaluate the response to furosemide stimulation (RFS), and assess TTT. All animals had DR and MRU before and after surgery and a third DR after surgery. Piglets were sacrificed after the final DR for renal histology. A total histologic score (THS) was generated. Results: Preoperative DR demonstrated nonobstructive RFS, timely TTT, and balanced SKF in all 20 kidneys. After ureteral ligature, MRU demonstrated pelvic dilatation in all piglets. The postoperative DRs revealed 12 kidneys with delayed TTT in one or both follow-ups. In these 12 kidneys, the SKF declined from 51% ± 4% to 18% ± 14%, and the THS was 9.0 ± 4.0. Three kidneys always had timely TTT, balanced SKF, and a THS of 1.8 ± 0.3. The contralateral, nonoperated kidneys had timely TTT and a THS of 1.2 ± 0.9. Postoperative scintigrams showed that 3 of 8 kidneys (38%) with an obstructive RFS had timely TTT, which demonstrates that TTT and RFS are not equivalent. Conclusion: In hydronephrosis, a delayed TTT of 99mTc-MAG3 accompanies both functional decline and histomorphologic restructuring in obstruction. According to the literature, a delayed TTT is determined by the filtration fraction of the kidneys and appears to identify an obstruction-mediated upregulated renin-angiotensin system.
Key Words:
glomerular filtration rate, radioisotope renography, renin-angiotensin system, ureteral obstruction
