Diuretic‐induced Urinary Flow Rates at Varying Clearances and their Relevance to the Performance and Interpretation of Diuresis Renography

Abstract

Minute-by-minute urinary flow rates before and after the intravenous injection of 40 mg frusemide were investigated in 29 well hydrated adult patients with varying creatinine clearances. Total urinary flow rates 3 to 6 min after frusemide ranged from 1 to 42 ml/min (mean 19). At 15 to 18 min after the diuretic, flow rates ranged from 8 to 46 ml/min (mean 23). Flow rates were proportional to creatinine clearance (r = 0.73; r = 0.8) and decreased with falling clearance, although significant diuresis (4 ml/min/kidney) was achieved down to single kidney clearances of 10 ml/min. Where single kidney clearances were less than 31 ml/min, single kidney flow rates of 10 ml/min or more were not guaranteed. Below this clearance, diuresis renography remains completely reliable and unequivocal in the majority of cases. However, perfusion pressure flow studies will not necessarily be urodynamically comparable and it should not be expected that the results of the two tests will agree in individual cases of upper tract dilatation. Recommended timing for frusemide administration should be 20 min into the test, or 15 min before radiopharmaceutical injection.

The physiological basis of renal nuclear medicine

“…This implies that the maximum diuresis produced by furosemide is 5 ml/min for a single healthy kidney, but in practice, it is considerably more [60], which would be consistent with the reduction of water reabsorption in the descending loop as a result of the loss of the osmolar gradient. This, plus the 5 ml/min available for reabsorption in the collecting ducts, would give 13 ml/min per kidney, which is close to the higher postfurosemide urinary outputs described by Upsdell et al [60]. In contrast, increased delivery of sodium to the distal tubule might be expected, if anything, to result in increased water reabsorption, but the effect would be small.…”

The physiological basis of renal nuclear medicine

“…This implies that the maximum diuresis produced by furosemide is 5 ml/min for a single healthy kidney, but in practice, it is considerably more [60], which would be consistent with the reduction of water reabsorption in the descending loop as a result of the loss of the osmolar gradient. This, plus the 5 ml/min available for reabsorption in the collecting ducts, would give 13 ml/min per kidney, which is close to the higher postfurosemide urinary outputs described by Upsdell et al [60]. In contrast, increased delivery of sodium to the distal tubule might be expected, if anything, to result in increased water reabsorption, but the effect would be small.…”

The Impact of Dust and Confinement on Fragmentation of Kidney Stones by Shockwave Lithotripsy in Tissue Phantoms

“…With medication, humans can produce urine up to 9.5 mL/min in a kidney. 19 However, this rate of irrigation was not sufficient for significant improvement in efficiency in experiment 2. Nonetheless, the result of experiment 2 demonstrates that removal of the fluid containing dust at a sufficient rate can improve lithotripsy.…”

Timing of diuretics in diuresis renography

“…The included articles were published between the years 1978 and 2020 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. The number of participants varied between 14 and 320.…”

“…The number of participants varied between 14 and 320. The radiopharmaceutical 99m Tc-MAG3 was administered in six studies [11, 17-19, 24, 25], 99m Tc-DTPA in five studies [9,12,13,20,22], 123 I-OIH in four studies [15,16,21,23], 99m Tc-EC in one study [10] and one study did not mention which radiopharmaceutical had been administered [14]. Five studies had a retrospective study design [15,17,22,24,25] and 12 studies had a prospective study design [9-14, 16, 18-21, 23].…”

“…The F − 15 method gave fewer equivocal results and led to clarification in cases of equivocal results compared to the F + 20 method [9,10,15]. Furthermore, an equivocal response in F + 20 could be converted to a normal response by F − 15 [14]. English et al reported that the F − 15 method could increase the specificity of diuresis renography in patients with equivocal pelviureteric junction obstruction [16].…”

The physiological basis of renal nuclear medicine

“…This implies that the maximum diuresis produced by furosemide is 5 ml/min for a single healthy kidney, but in practice, it is considerably more [60], which would be consistent with the reduction of water reabsorption in the descending loop as a result of the loss of the osmolar gradient. This, plus the 5 ml/min available for reabsorption in the collecting ducts, would give 13 ml/min per kidney, which is close to the higher postfurosemide urinary outputs described by Upsdell et al [60]. In contrast, increased delivery of sodium to the distal tubule might be expected, if anything, to result in increased water reabsorption, but the effect would be small.…”

The Impact of Dust and Confinement on Fragmentation of Kidney Stones by Shockwave Lithotripsy in Tissue Phantoms

“…With medication, humans can produce urine up to 9.5 mL/min in a kidney. 19 However, this rate of irrigation was not sufficient for significant improvement in efficiency in experiment 2. Nonetheless, the result of experiment 2 demonstrates that removal of the fluid containing dust at a sufficient rate can improve lithotripsy.…”

Timing of diuretics in diuresis renography

“…The included articles were published between the years 1978 and 2020 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. The number of participants varied between 14 and 320.…”

“…The number of participants varied between 14 and 320. The radiopharmaceutical 99m Tc-MAG3 was administered in six studies [11, 17-19, 24, 25], 99m Tc-DTPA in five studies [9,12,13,20,22], 123 I-OIH in four studies [15,16,21,23], 99m Tc-EC in one study [10] and one study did not mention which radiopharmaceutical had been administered [14]. Five studies had a retrospective study design [15,17,22,24,25] and 12 studies had a prospective study design [9-14, 16, 18-21, 23].…”

“…The F − 15 method gave fewer equivocal results and led to clarification in cases of equivocal results compared to the F + 20 method [9,10,15]. Furthermore, an equivocal response in F + 20 could be converted to a normal response by F − 15 [14]. English et al reported that the F − 15 method could increase the specificity of diuresis renography in patients with equivocal pelviureteric junction obstruction [16].…”

The physiological basis of renal nuclear medicine

“…This implies that the maximum diuresis produced by furosemide is 5 ml/min for a single healthy kidney, but in practice, it is considerably more [60], which would be consistent with the reduction of water reabsorption in the descending loop as a result of the loss of the osmolar gradient. This, plus the 5 ml/min available for reabsorption in the collecting ducts, would give 13 ml/min per kidney, which is close to the higher postfurosemide urinary outputs described by Upsdell et al [60]. In contrast, increased delivery of sodium to the distal tubule might be expected, if anything, to result in increased water reabsorption, but the effect would be small.…”

The Impact of Dust and Confinement on Fragmentation of Kidney Stones by Shockwave Lithotripsy in Tissue Phantoms

“…With medication, humans can produce urine up to 9.5 mL/min in a kidney. 19 However, this rate of irrigation was not sufficient for significant improvement in efficiency in experiment 2. Nonetheless, the result of experiment 2 demonstrates that removal of the fluid containing dust at a sufficient rate can improve lithotripsy.…”

Timing of diuretics in diuresis renography

“…The included articles were published between the years 1978 and 2020 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. The number of participants varied between 14 and 320.…”

“…The number of participants varied between 14 and 320. The radiopharmaceutical 99m Tc-MAG3 was administered in six studies [11, 17-19, 24, 25], 99m Tc-DTPA in five studies [9,12,13,20,22], 123 I-OIH in four studies [15,16,21,23], 99m Tc-EC in one study [10] and one study did not mention which radiopharmaceutical had been administered [14]. Five studies had a retrospective study design [15,17,22,24,25] and 12 studies had a prospective study design [9-14, 16, 18-21, 23].…”

“…The F − 15 method gave fewer equivocal results and led to clarification in cases of equivocal results compared to the F + 20 method [9,10,15]. Furthermore, an equivocal response in F + 20 could be converted to a normal response by F − 15 [14]. English et al reported that the F − 15 method could increase the specificity of diuresis renography in patients with equivocal pelviureteric junction obstruction [16].…”