J Nucl Med. 2007; 48 (Supplement 2):125P
General Clinical Specialties: Renal/Electrolyte/Hypertension
Renal/Electrolyte/Hypertension |
A renal protocol for all indications: MAG3 with simultaneous injection of furosemide (MAG3-F0): A fifteen year experience
George Sfakianakis1,
Efrosyni Sfakianaki1,
Mike Georgiou1,
Aldo Serafini1,
Shabbir Ezuddin1 and
Russ Kuker1
1 Radiology/Nuclear Medicine, University of Miami/Jackson Memorial Medical Center, Miami, Florida
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Objectives: Current clinical requirements mandate the existence of a renal diuretic protocol, which is fast and easy, convenient for both the patient and the technologist, is applicable in all ages and for all indications and provides both diagnostic and prognostic information. Methods: A 25 min protocol, following oral hydration, no bladder catheterization and simultaneous injection of MAG3 and furosemide (MAG3-F0) was initiated 15 years ago. It was used initially for evaluation of the drainage but emerged as a protocol to evaluate the renal parenchyma as well. Results of this protocol have been published individually, per clinical application. Results: MAG3-F0 helped specify congenital disorders and prognosticate outcomes. For obstruction, in the newborn, a rising renogram mandates intervention, whereas a downsloping one predicts spontaneous resolution; in children or adults, pre op or post op, when the cortex was visualized and drained normally, there was no obstruction, even if urine was retained within a dilated collecting system or an extrarenal pelvis. For diseases of the renal parenchyma, the protocol enabled the diagnosis of acute pyelonephritis (APN) revealing the "regional parenchymal dysfunction", diagnostic of APN. Diffuse parenchymal diseases were characterized by increased residual cortical activity (RCA) and their progression was manifested as a deterioration of RCA. End stage renal disease was characterized by lack of accumulation and retention. Trauma and leaks were identified with specific patterns. In renovascular hypertension (RVH), an increase in RCA after ACE Inhibitors is diagnostic of RVH and prognostic of the beneficial effect of angioplasty on hypertension. In renal colic, stratification was possible into (a) complete or severe obstruction requiring immediate intervention,(b) spontaneous decompression(stunned kidney) and (c) no recent obstruction. In transplants, it enabled differentiation of ATN, acute or chronic rejection and nephrotoxicity, and identified infarcts, RVH, leaks and obstruction. A quantification of renal function was finally possible. Conclusions: The clinical usefulness of MAG3-F0 resulted in up to 15 studies per day at our Center.
