Diclofenac Treatment Prolongs Renal Transit Time in Acute Ureteral  Obstruction: A Renographic Study

Kinn, Anne‐Charlotte; Larsson, Stig; Nelson, Elisabeth; Jacobsson, Hans

doi:10.1159/000052366

Cited by 8 publications

(5 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is considerably higher in the Finlayson and Reid model than in the other two models and is due to the slower flow velocity that results from the wider collecting duct diameters used in the Finlayson and Reid model (table 1). Recent studies suggest that the shorter times used in the Kok and Khan and Robertson models are more in keeping with the transit times of fluid measured in the non-obstructed kidney [16, 17], i.e. about 3–4 min.…”

Section: Comparison Of Models Of Caox Stone Formationmentioning

confidence: 94%

“…[Even if the Finlayson and Reid model is correct, the transit time is only increased to 10–11 min – still insufficient for a single crystal to grow large enough to be trapped in the wider collecting tubules of their model (25–200 µm).] For the ‘free-particle’ model to be possible, there has to be some other mechanism by which the passage of the initially formed nuclei is delayed in order for the individual crystals to grow large enough to be trapped within the 3–4 min transit times suggested by studies in humans [17]and dogs [16]. …”

Section: Comparison Of Models Of Caox Stone Formationmentioning

confidence: 99%

See 1 more Smart Citation

Kidney Models of Calcium Oxalate Stone Formation

Wg¹

2004

Nephron Physiol

View full text Add to dashboard Cite

This review compares and contrasts three mathematical models used to describe the flow of urine through the renal tubule and the composition of tubular fluid throughout the length of the nephron. From these data the relative supersaturation of tubular fluid with respect to calcium oxalate (CaOx) is calculated at various points along the tubule. This shows that glomerular filtrate is well undersaturated with respect to CaOx and is still undersaturated at the end of the proximal tubule. By the end of the descending limb of the loop of Henle, it is highly supersaturated as a result of water reabsorption and CaOx may nucleate in this region, particularly when the tubular concentration of oxalate is increased. Supersaturation falls slightly by the end of the ascending limb and becomes briefly undersaturated again in the short distal tubule. The final water adjustment in the collecting tubules causes the supersaturation to rise to a very high value by the end of the collecting duct and spontaneous CaOx crystalluria is likely to occur. The review also examines the probability of these crystals growing large enough to be trapped at some point in the nephron within the transit time of tubular fluid from glomerular capsule to ducts of Bellini. All three models agree that, under normal conditions, the likelihood of individual crystals growing large enough to be trapped within the measured urine transit time of 3–4 min is very small. It is concluded that either there has to be aggregation of crystals or some other factor that delays the passage of crystals for them to grow large enough to become lodged at some point in the nephron. Three new hydrodynamic factors are introduced that may lead to delay of crystal passage: (a) fluid drag close to the tubule walls; (b) the drag effect of tubular walls on particles travelling close to the tubule walls, and (c) the effect of gravity on particles travelling in upward-draining sections of tubule. When these factors are introduced into the mathematical model of urine flow and tubular concentration, it is shown that any crystals that form at the end of the descending limb of the loop of Henle and which travel close to the tubular walls may be delayed long enough to grow large enough to become trapped further down the nephron, particularly in upward-draining sections of the nephron. This possibility becomes increasingly significant as urinary oxalate concentration increases. Crystals that nucleate in the late collecting duct, however, are readily passed as small crystals and are at no risk of being trapped in the tubular system. These predictions are used to explain data on the effects of oxalate loading on CaOx crystalluria in stone formers and normal controls. The data are interpreted as showing that if the additional hydrodynamic factors are added to the mathematical model of nephron function, then the ‘free-particle’ model of calcium stone formation is still possible. This possibility will be further enhanced if crystal aggregation also takes place during the period when crystal pas...

show abstract

Section: Comparison Of Models Of Caox Stone Formationmentioning

confidence: 94%

Section: Comparison Of Models Of Caox Stone Formationmentioning

confidence: 99%

Kidney Models of Calcium Oxalate Stone Formation

Wg¹

2004

Nephron Physiol

View full text Add to dashboard Cite

show abstract

“…Kritisch hinterfragt werden sollte auch eine Therapie mit Medikamenten, die das Bradykinin-Prostaglandin-System beeinflussen wie z. B. Aspirin oder Diclofenac [16]. Für andere blutdruckwirksame Medikamente ist ein Effekt auf das Ergebnis der Untersuchung nicht belegt, weshalb sie bevorzugt eingesetzt werden sollten, wenn ein komplettes Absetzen der Antihypertensiva klinisch nicht möglich ist.…”

Section: Medikamenteninteraktionenunclassified

Interventionelle Verfahren in der nuklearmedizinischen Nierenfunktionsdiagnostik

Kletter¹

2003

Der Nuklearmediziner

View full text Add to dashboard Cite

EinleitungPharmakologische Interventionen sind in der nuklearmedizinischen Diagnostik keine Seltenheit. Sie finden seit langem in der Schilddrüsendiagnostik, in der Diagnose der koronaren Herzkrankheit, aber auch bei der Hirnszintigraphie Anwendung. Auch in der Nierenfunktionsdiagnostik gehört die pharmakologische Intervention heute zur Routine und ist bei der Fragestellung einer Hypertonie und bei der Abklärung von Harnabflussstörungen unverzichtbar. Vorteile einer pharmakologischen Intervention sind sowohl höhere Sensitivität als auch Spezifität von Unter-suchungen bei gezielten Fragestellungen. Nachteile sind mögliche Nebenwirkungen als Folge der Verabreichung pharmakologisch wirksamer Substanzen und meist eine Verlängerung des Untersuchungsablaufes. Auf jeden Fall ist auf eine gute Standardisierung der Verfahren zu achten.Für interventionelle Verfahren in der Nierenfunktionsdiagnostik wurden in den letzten Jahren Richtlinien für die Durchführung bei der Hypertonieabklärung und zur Beurteilung von Harnabflussstörungen erarbeitet. ZusammenfassungDie Isotopennephrographie stellt ein sehr sensitives Verfahren dar, das auch geringe Veränderungen der Organfunktion erfasst. Durch interventionelle Maûnahmen, insbesondere durch pharmakologische Intervention, kann vor allem die Spezifität der Methode für bestimmte klinische Fragestellungen wesentlich erhöht werden. Der vorliegende Übersichtsartikel fasst den gegenwärtigen Stand der interventionellen Nierenfunktionsdiagnostik bei der Abklärung einer Hypertonie und der Beurteilung von Harnabflussstörungen zusammen. Es werden sowohl methodische Aspekte wie Durchführung der Untersuchung, Auswerteverfahren und mögliche Fehlerquellen als auch die klinische Wertigkeit der Verfahren besprochen. Schlüsselwörter Nierenfunktionsszintigraphie´Hypertonie´Harnabflussstörung AbstractRadionuclide kidney function studies are very sensitive measures and renography allows to detect even slight alterations of organ function. Interventions, especially pharmacologic stress may permit observation of variations in kidney function which are typical for a disease. Therefore in clinical routine, pharmacologic intervention augments the specificity of the test significantly. This review article summarizes the state of the art in the application of interventional renography in the question of hypertension and urinary outflow obstruction. Methodological aspects as practice and protocols, data analysis and diagnostic parameters and limitations and pitfalls are described. The diagnostic potential for the clinical indications is discussed.

show abstract

“…Furthermore, the NSAID diclofenac is the drug most commonly used to relieve kidney pain and uretic colic (9,10). Only 2 studies using 99m Tc-mercaptoacetyltriglycine ( 99m Tc-MAG3) have been performed (11,12). One reported that diclofenac treatment can lead to overestimation of ureteral stone disease by delaying renal excretion predominantly on the side of the calculus (11).…”

mentioning

confidence: 99%

“…Only 2 studies using 99m Tc-mercaptoacetyltriglycine ( 99m Tc-MAG3) have been performed (11,12). One reported that diclofenac treatment can lead to overestimation of ureteral stone disease by delaying renal excretion predominantly on the side of the calculus (11). The other showed that diclofenac caused a profound disruption to both uretic peristalsis and the 99m Tc-MAG3 renogram curve (12).…”

mentioning

confidence: 99%

Effect of the NSAID Diclofenac on ^99mTc-MAG3 and ^99mTc-DTPA Renography

Mustafa

Elgazzar

2013

J Nucl Med

View full text Add to dashboard Cite

Renal function and disease are commonly evaluated by radionuclide studies. The choice of radiopharmaceutical agent for various studies is crucial for proper interpretation. 99m Tcmercaptoacetyltriglycine ( 99m Tc-MAG3) is excreted almost exclusively by the renal tubules, whereas 99m Tc-diethylenetriamine pentaacetic acid ( 99m Tc-DTPA) is predominantly excreted by glomerular filtration. The present study compared the effect of the nonsteroidal antiinflammatory drug (NSAID) diclofenac, which is the most commonly used drug to relieve kidney pain, on the kinetic behavior of administered 99m Tc-MAG3 and 99m Tc-DTPA in experimental animals. Methods: Two groups of 12 New Zealand White rabbits ( 99m Tc-MAG3 and 99m Tc-DTPA) were used for the renography. Each rabbit served as its own control. The animals were given 60 mL of saline intravenously 30 min before each renographic study. A baseline study (control) was done by injecting 48 MBq (1.3 mCi) of 99m Tc-MAG3, and renography was performed. Two days later, a single intravenous dose of diclofenac (2 mg/kg) (treated animals) was given, and after 20 min, 99m Tc-MAG3 renography was performed. This procedure was repeated for the 99m Tc-DTPA group after administration of 96 MBq (2.6 mCi) of the tracer. Dynamic images (as 2-s frames for the first minute and 30-s frames for the next 30 min on a 64 · 64 matrix) were acquired using a g-camera equipped with a low-energy highresolution collimator interfaced with a computer. Regions of interest were drawn over the whole kidneys. Time-activity curves were generated from the region of interest. Time to peak activity (T max ), time from peak to 50% activity (T 1/2 ), and the uptake slope of each kidney were calculated from the renograms for control and treated rabbits. Results: Administration of diclofenac shifted the experimental renogram curves to the right, compared with the control curves, indicating that there was a delayed renal uptake of the 2 tracers and clearance of the radioactivity. The calculated average values of T max for control and treated rabbits using 99m Tc-MAG3 were 1.8 6 0.5 and 6.35 6 0.4 min, respectively, whereas those of 99m Tc-DTPA were 3.4 6 0.4 and 18.2 6 2 min, respectively. The T 1/2 for control and treated rabbits for 99m Tc-MAG3 were 3.2 6 0.07 and 6.6 6 0.07 min, respectively, whereas those for 99m Tc-DTPA were 10.1 6 1 and 35 6 4 min, respectively. The differences were statistically significant (P , 0.05). Conclusion: This study showed that diclofenac delayed both T max and T 1/2 . The NSAID-induced kinetic changes were considerably greater for 99m Tc-DTPA than for 99m Tc-MAG3. On the basis of these findings, it is suggested that 99m Tc-MAG3 be used to perform renography for studies involving the use of NSAID administration to decrease any change that may occur due to the type of tracer and not to the condition of the kidney.

show abstract

Diclofenac Treatment Prolongs Renal Transit Time in Acute Ureteral Obstruction: A Renographic Study

Cited by 8 publications

References 8 publications

Kidney Models of Calcium Oxalate Stone Formation

Kidney Models of Calcium Oxalate Stone Formation

Interventionelle Verfahren in der nuklearmedizinischen Nierenfunktionsdiagnostik

Effect of the NSAID Diclofenac on ^99mTc-MAG3 and ^99mTc-DTPA Renography

Contact Info

Product

Resources

About

Diclofenac Treatment Prolongs Renal Transit Time in Acute Ureteral Obstruction: A Renographic Study

Cited by 8 publications

References 8 publications

Kidney Models of Calcium Oxalate Stone Formation

Kidney Models of Calcium Oxalate Stone Formation

Interventionelle Verfahren in der nuklearmedizinischen Nierenfunktionsdiagnostik

Effect of the NSAID Diclofenac on 99mTc-MAG3 and 99mTc-DTPA Renography

Contact Info

Product

Resources

About

Effect of the NSAID Diclofenac on ^99mTc-MAG3 and ^99mTc-DTPA Renography