Evaluation of Renal Function and Morphology in Children by ^99mTc‐DTPA Gamma Camera Renography

Abstract

The purpose of the present investigation was to evaluate the use of 99mTc-DTPA (diethylenetriaminepenta-acetate) gamma camera renography for the study of kidney function as well as morphology. Sixty-nine children with urinary tract infection or congenital hydronephrosis aged 6 days to 13.6 years were studied. A method for determination of the glomerular filtration rate (GFR) from the recorded curves without use of blood or urine samples was tested in 65 consecutive children. From each renogram an uptake index was determined. After a weight/height correction the sum of right and left kidney uptake index correlated with total GFR determined from plasma clearance of 51Cr-EDTA (ethylenediaminetetra-acetate) measured on the same day (r = 0.96). The relative standard error of estimating GFR from the renograms was 10.7% at GFR = 100 ml/min and 14.6% at GFR = 50 ml/min. In a subgroup including 20 children no difference was found in kidney morphology and length studied by renography and intravenous urography, the latter providing more details concerning the urinary tract. Relative kidney length did not correlate with relative renal function determined by renography, emphasizing the difficulty in determination of relative renal function by urography. In conclusion, not only relative but also absolute renal function (GFR) can be determined in children by 99mTc-DTPA renography; at the same time kidney and urinary tract morphology are evaluated. In our hands, 99mTc-DTPA renography has become a useful diagnostic tool, lowering the need for the more cumbersome intravenous urography and 51Cr-EDTA plasma clearance. However, intravenous urography is mandatory for the detailed study of the urinary tract, and use of the 51Cr-EDTA plasma clearance technique is necessary when a very reliable determination of GFR is wanted.

Age Factor in Compensatory Hypertrophy of the Kidney Evaluated by99mTc-DTPA Renography

“…It has been well documented that the remaining renal function increases promptly after unilateral nephrec tomy [1], However, we observed that postnephrectomy compensatory renal growth varies considerably in differ ent patients [2] and might be a variable phenomenon. The aim of the study is to evaluate the age factor in compensatory renal hypertrophy after unilateral ne phrectomy with a new method, 99mTc-DTPA renogra phy, to detect the individual renal function.…”

Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of urinary tract infection in children: a systematic review and economic model

“…Seven studies evaluated 99m Tc-DMSA, 133,138,141,193,196,214,217 and one study evaluated 123 I-hippuran. 218 Half of these studies did not include an appropriate spectrum of patients.…”

“…218 Half of these studies did not include an appropriate spectrum of patients. The quality of reporting was poor: the majority of studies (6/8) did not report patient selection criteria; 133,138,141,193,196,214 five studies provided inadequate description of the reference standard and/or the index test; 133,193,196,217,218 half of all studies did not report sufficient information to assess the avoidance of test review bias, 133,141,196,214 and four studies did not report sufficient information to assess avoidance of disease progression bias. 133,214,217,218 Disease progression bias was a problem in two studies 141,196 and partial verification bias in another study.…”

“…Only half of the studies included an appropriate patient spectrum 133,193,196,214 and only two provided sufficient details on selection criteria. 217,218 Half of the studies reported that both test review bias and reference standard review bias had been avoided, 138,193,217,218 but only one study reported that the same clinical information was available when test results were interpreted as would be available in practice. 217 None of the studies provided an explanation as to why some of the children did not receive both the index test and reference standard.…”

Comparison of methods for determination of glomerular filtration rate: low and high-dose Tc-99m-DTPA renography, predicted creatinine clearance method, and plasma sample method

“…Camera-based methods for measuring renal uptake of Tc-99m DTPA without blood or urine sampling have been widely used [6]. The method introduced by Gates [7] has been the most common routine method [8,9].…”