Nuc Med Renal Scans

Inidication

Acute and chronic renal failure
Unilateral/bilateral renal disease (space occupying lesions included)
Obstructive uropathy
Renovascular hypertension
Status post renal transplantation

Contraindications

Dehydration

Diuretics

Radionuclide

Tc99m Mag3

Tubular

10-20 mCi

IV BOLUS

Tc99m DTPA

Glomerular

10-20 mCi

imaging

Gamma Camera

LEHR

140 keV window 20%

patient is supine

FOV kidneys in upper hemisphere

elbows as a marker

aquiqisition

flow

2 seconds a frame for 1 to 2 mins

dynamic

15-30 seconds a frame for 30 mins

post void image per protocol

patient prep

IV

hydrate

void before and after imaging

processing

time activity curve

ROI's

same as functional renogram

Checking for obstruction

mechanical

Stones

physical

hydronephrosis

kidney will no empty even with lasix
if obstructed

administer slow injection of lasix

20 minutes after scan begins

time curve includes t1/2 and diuretic 1/2 marks

Same as renogram, just pre dose patient with ACE inhibitor

ACE Inhibitors
Enalapril 40ug/kg IV or Captopril 50 mg PO

Enalapril 15 min prior

Captopril 1 hour prior

blocks conversion of A1 to A2
causing to lowering of GFR

GFR drops causiing

decrease in kidney output (compared to baseline)

Indication: evaluates for unexplained renal hypertension

AKA RENAL ARTERY STENOSIS

Prep

hydration

NPO 4-6 hours

monitor patient BP at beginning of test

repeat every 15 min during test and document

discontinue meds 4 days prior

Ace inhibitors

diuretics

morphologic imaging

Dose

Tc99m-DMSA

5 mCi

Indication

pyelonephritis

inflammation of kidney

differentiation of renal mass from normal variant

Confirmation of column of Bertin

renal pyramids

Contraindication

dehydration

UTI's within 30 days

Prep

well hydrated

void before imaging

IV

image aquisition

2 hours delay

500 k counts

Spect

rotate 180degrees, step and shoot 40 views per head, 3 degrees /stop, 20-40 sec/stop

processing

SPECT image processing looking for cold lesions

Vesicoureteral Reflux Study

Direct and indirect

Direct is

Indirect is

Dose

Tc99m SC

1 mCi

Tc99m Tc-DTPA

1 mCi

Indication

Evaluation and detection of vesicoureteral reflux

Contraindication

Prep

Foley Catheter

Cover bed and collimators with chucks

Image aquisition

4 phase

filling

PRevoid

Void

POST VOiD

Supine or posterior imaging

FOV

bladder in bottom quandrant

kidneys top quadrants