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Title: Correlates of diuretic renography in experimental hydronephrosis

Abstract

We studied the correlations between diuretic renographs and kidney function in experimental hydronephrosis in rabbits. Features of furosemide-stimulated /sup 99m/Tc-diethylenetriamine-pentaacetic acid renographs were compared to the growth rate, thirst test and endogenous creatinine clearance rate in a chronic solitary-kidney animal model. Intravenous pyelograms, done four weeks after laparotomy, left nephrectomy, bladder resection and constriction of the right pyeloureteric junction, showed signs of obstruction in all the 12 animals of the experimental group. An absent tracer washout after intravenous furosemide, found in five animals, was associated with retarded growth, isosthenuria and an abnormal creatinine clearance. In all of the other seven animals, a distinct tracer washout after intravenous furosemide was accompanied with a normal growth rate and creatinine clearance. However, no one of these seven animals had a normal ability to retain water and concentrate urine in the thirst test. We conclude that, in this experimental model, a furosemide-induced tracer washout from the kidney pelvis cannot be taken as a proof of the absence of any upper urinary tract obstruction.

Authors:
; ; ;
Publication Date:
Research Org.:
Turku Univ. Central Hospital (Finland)
OSTI Identifier:
6463638
Resource Type:
Journal Article
Resource Relation:
Journal Name: J. Urol.; (United States); Journal Volume: 141:2
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CREATININE; RENAL CLEARANCE; KIDNEYS; BIOMEDICAL RADIOGRAPHY; UROGENITAL SYSTEM DISEASES; DIAGNOSIS; BIOLOGICAL MODELS; DTPA; DYNAMIC FUNCTION STUDIES; ISOMERIC NUCLEI; NEPHRECTOMY; ORGANOMETALLIC COMPOUNDS; RABBITS; TECHNETIUM 99; TRACER TECHNIQUES; AMINO ACIDS; ANIMALS; AZOLES; BETA DECAY RADIOISOTOPES; BETA-MINUS DECAY RADIOISOTOPES; BODY; CARBOXYLIC ACIDS; CHELATING AGENTS; CLEARANCE; DIAGNOSTIC TECHNIQUES; DISEASES; DRUGS; EXCRETION; HETEROCYCLIC COMPOUNDS; HOURS LIVING RADIOISOTOPES; IMIDAZOLES; IMINES; INTERMEDIATE MASS NUCLEI; ISOMERIC TRANSITION ISOTOPES; ISOTOPE APPLICATIONS; ISOTOPES; MAMMALS; MEDICINE; NUCLEAR MEDICINE; NUCLEI; ODD-EVEN NUCLEI; ORGANIC ACIDS; ORGANIC COMPOUNDS; ORGANIC NITROGEN COMPOUNDS; ORGANS; RADIOISOTOPES; RADIOLOGY; RADIOPROTECTIVE SUBSTANCES; SURGERY; TECHNETIUM ISOTOPES; VERTEBRATES; YEARS LIVING RADIOISOTOPES; 550601* - Medicine- Unsealed Radionuclides in Diagnostics

Citation Formats

Kekomaeki, M.R., Rikalainen, H., Ruotsalainen, P., and Bertenyi, C. Correlates of diuretic renography in experimental hydronephrosis. United States: N. p., 1989. Web.
Kekomaeki, M.R., Rikalainen, H., Ruotsalainen, P., & Bertenyi, C. Correlates of diuretic renography in experimental hydronephrosis. United States.
Kekomaeki, M.R., Rikalainen, H., Ruotsalainen, P., and Bertenyi, C. 1989. "Correlates of diuretic renography in experimental hydronephrosis". United States. doi:.
@article{osti_6463638,
title = {Correlates of diuretic renography in experimental hydronephrosis},
author = {Kekomaeki, M.R. and Rikalainen, H. and Ruotsalainen, P. and Bertenyi, C.},
abstractNote = {We studied the correlations between diuretic renographs and kidney function in experimental hydronephrosis in rabbits. Features of furosemide-stimulated /sup 99m/Tc-diethylenetriamine-pentaacetic acid renographs were compared to the growth rate, thirst test and endogenous creatinine clearance rate in a chronic solitary-kidney animal model. Intravenous pyelograms, done four weeks after laparotomy, left nephrectomy, bladder resection and constriction of the right pyeloureteric junction, showed signs of obstruction in all the 12 animals of the experimental group. An absent tracer washout after intravenous furosemide, found in five animals, was associated with retarded growth, isosthenuria and an abnormal creatinine clearance. In all of the other seven animals, a distinct tracer washout after intravenous furosemide was accompanied with a normal growth rate and creatinine clearance. However, no one of these seven animals had a normal ability to retain water and concentrate urine in the thirst test. We conclude that, in this experimental model, a furosemide-induced tracer washout from the kidney pelvis cannot be taken as a proof of the absence of any upper urinary tract obstruction.},
doi = {},
journal = {J. Urol.; (United States)},
number = ,
volume = 141:2,
place = {United States},
year = 1989,
month = 2
}
  • The diuretic renogram provides a previously unavailable noninvasive method for assessing and following urinary tract dilation of diverse cause, and defining true obstruction in children. Technetium-99m-DTPA (diethylenetriaminepentaacetic acid) is injected intravenously and a posteriorly placed gamma scintillation camera used to image the kidneys, ureters, and bladder. Furosemide is subsequently injected to stimulate a diuresis, and the washout pattern of isotope is monitored (time-activity histogram). Nonobstructive, obstructive, and poor renal function patterns were seen. Forty patients with varying degrees of hydroureteronephrosis were evaluated. Tracings were performed serially and compared with the clinical course in time, as well as with pressure flowmore » studies and operative findings. All patients with a nonobstructed diuretic renogram did well, except for 1 boy in whom ureteropelvic obstruction developed later. Difficulty in evaluating the obstructive renogram pattern occurred only in some children with severe (grade V) hydronephrosis. Further standardization of the diuretic renogram with regard to time of diuretic injection, state of patient hydration, and regions of imaging may improve diagnostic accuracy.« less
  • Conventional radionuclide renography has been modified to include a pharmacologic intervention by administration of intravenous furosemide. The procedure is applied in patients with hydroureteronephrosis to distinguish dilated, nonobstructed systems from those with significant mechanical obstruction. Diagnostic patterns are derived from computer-generated time-activity histograms that depict the accumulation of radiotracer prior to diuresis and in response to diuresis. In dilated, nonobstructed systems, increased urine flow following diuresis causes a decline or washout of activity. In significantly obstructed systems, there is a failure of tracer activity to decrease in response to diuresis. The procedure is applied most commonly in suspected ureteropelvic junctionmore » and ureterovesical junction obstruction. The significance of residual urinary tract dilatation following corrective surgery also can be readily assessed. The major current limitation to the technique is poor renal function with inadequate response of urine flow to diuresis.« less
  • Diuretic radionuclide renography is accurate in the assessment of nephroureteral dilation. We have extended this technique to include evaluation of nephroureteral dilation noted on the bone scans of two patients.
  • Means of preventirg hydronephrosis, developing from injury to the ureter during radiotherapy of gynecologic carcinoma, were investigated. These studies were based on previous observations that cortisone tended to reduce the incidence of ureteral strictures following irradiation of cervical carcinoma. Female rats were irradiated with 300 r, delivered to a 2 x 4.5 cm abdominal area, in repeated doses to give a total of 4500 r. The animals were injected intramuscularly with 0.5 mg of a crystalline suspension of prednisolone every week during and after irradiation, and control animals were treated with folliclestimulating hormone (FSH). Pyelonephritis developed in 44% of FSH-treatedmore » animals compared with only 18% in prednisolone-treated rats; severe ureteral sclerosis was found in 36 and 20%; and histological detectable hydronephrosis was seen in 80 and 0%, respectively. It was concluded that this anti-inflammatory steroid inhibits development of the 2 factors which appear most responsible for radiation-induced hydronephrosis, namely, ascending pyelonephritis and ureteral sclerosis. This was confirmed in human subjects. In 50 women undergoing radiation treatment of uterine carcinoma, administration of a total dose of 500 mg prednisolone over a 3- month period completely prevented hydronephrosis, whereas this complication arose in 10% of women who did not receive this steroid. (H.H.D.)« less