Diuretic renography
-
Upload
drsivasubramaniyan-viswanathan -
Category
Health & Medicine
-
view
522 -
download
2
description
Transcript of Diuretic renography
![Page 1: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/1.jpg)
![Page 2: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/2.jpg)
![Page 3: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/3.jpg)
DIURETIC DIURETIC RENOGRAPHYRENOGRAPHY
DR.V.Siva Subramaniyan
Head, Dept. of Nuclear Medicine ,
SSSIHMS, Prashanthigram, Puttaparthy &
SSSIHMS, Whitefield, Bangalore .
![Page 4: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/4.jpg)
OBJECTIVES
WHAT IS THE CAUSE ?
IS INTERVENTION APPROPRIATE ?
WHAT IS APPROPRIATE ?
WHAT IS THE OUT COME ?
WRONG WAY
![Page 5: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/5.jpg)
INDICATIONS
IDIOPATHIC HYDRONEPHROSIS
URINARY CALCULI
URINARY DIVERSION
![Page 6: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/6.jpg)
Renal Radiopharmaceuticals
![Page 7: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/7.jpg)
RENAL RADIOPHARMACEUTICAL
I - 131 0I H
TC - 99 m-DTPA
TC –99 m- DMSA
TC- 99 m- MAG 3
TC -99 m- EC
![Page 8: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/8.jpg)
Tracer 99 Tc m – DTPA.
Dose : 3-5 mCi
Route : IV injection
Preparation : Proper hydration.
PROCEDURE
![Page 9: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/9.jpg)
SEQUENTIAL ANALYSIS
IMAGE ANALYSIS
GFR ESTIAMTION
RENOGRAPHIC CURVE ANALYSIS
DIURETIC RESPONSE
![Page 10: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/10.jpg)
![Page 11: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/11.jpg)
OBSTRUCTIVE PATTERNS
![Page 12: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/12.jpg)
OBSTRUCTIVE PATTERNS
![Page 13: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/13.jpg)
Diuretic Response Types
![Page 14: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/14.jpg)
NORMAL STUDY
![Page 15: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/15.jpg)
![Page 16: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/16.jpg)
![Page 17: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/17.jpg)
![Page 18: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/18.jpg)
![Page 19: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/19.jpg)
ECTOPIC KIDNEYS
![Page 20: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/20.jpg)
![Page 21: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/21.jpg)
![Page 22: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/22.jpg)
![Page 23: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/23.jpg)
![Page 24: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/24.jpg)
Super Numerary Kidney
![Page 25: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/25.jpg)
![Page 26: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/26.jpg)
![Page 27: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/27.jpg)
![Page 28: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/28.jpg)
![Page 29: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/29.jpg)
![Page 30: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/30.jpg)
![Page 31: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/31.jpg)
![Page 32: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/32.jpg)
![Page 33: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/33.jpg)
FOLLOW UP
![Page 34: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/34.jpg)
![Page 35: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/35.jpg)
![Page 36: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/36.jpg)
![Page 37: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/37.jpg)
SSSIHMS PRASHANTIGRAM_________________________________________________________ Name: Ramalingappa Age / Sex: 30/M Hospital No: 45236/k1 Procedure: Dynamic Renal Date: 20/05/02 N.M N0. RD /4414/02 Tracer: Tc-99m DTPA Dose: 5 Mci Route: Intravenous Protocol: Gates Diuretic: Lasix 40 mg i.v Time: F 0 Hydration: plenty of oral fluid Clinical History: Case of GUTB. Completed treatment. Known case of right poorly functioning kidney. To check Isotope function of both kidneys and plan for surgery. IMAGES
INTERPRETATION K I D N E Y S C O R T E X Site Size Position Visualization Delineation Defect Contour RT. Normal ContractedNormal Delayed Nil Nil Irregular
LT. Normal Normal Normal Prompt Good Nil Smooth C O L L E C T I N G S Y S T E M U R E T E R Visualisn. Delineation Uptake late fill. Visualisn. Accumulation Insertion RT. Not seen Nil Nil Nil Not seen Nil --- LT. Prompt Good Increased Nil Faint Trace Normal R E N O G R A P H I C C U R V E A N A L Y S I S PHASE: Uptake Secretory Excretory Diur.response G.F.R % Function RT. Flat Flat Flat Nil 3 ml 8 % LT. Vertical Slope L.O.C Type III a 42 ml 82 % TOTAL GFR 45 ml / min. IMPRESSION:
Features suggestive of Left impaired functioning Kidney with Rt.side Non-functioning kidney +.
DR.V.SIVASUBRAMANIYAN, Consultant Nuclear Medicine Physician ____________________________________________________________________________
![Page 38: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/38.jpg)
SSSIHMS PRASHANTIGRAM____________________________________________________________
Name: Ramalingappa Age / Sex: 30/M Hospital No: 45236/ K1
Procedure: Dynamic Renal Date: 12/09/02 N.M N0. RD/4724/2002 Tracer: Tc-99m DTPA Dose: 5 Mci Route: Intravenous Protocol: Gates Diuretic: Lasix 40 mg i.v Time: F 0 Hydration: plenty of oral fluid Clinical History: A case of Genito- urinary Tuberculosis . Rt. Non- Functioning Kidney and Left Poorly functioning Kidney. Lt. side DJ stenting done. For follow up Functional evaluation.
IMAGES
INTERPRETATION K I D N E Y S C O R T E X Site Size Position Visualization Delineation Defect Contour RT. –Normal Normal Normal Nil Nil Nil Nil
LT. Normal Normal Normal Prompt Good Nil Smooth
C O L L E C T I N G S Y S T E M U R E T E R Visualisn. Delineation Uptake late fill. Visualisn. Accumulation Insertion RT. Nil Nil Nil Nil Nil Nil ---- LT. Prompt Good Increased Nil Faint Trace Normal
R E N O G R A P H I C C U R V E A N A L Y S I S
PHASE: Uptake Secretory Excretory Diur.response G.F.R % Uptake RT. –Flat Flat Flat Type II 4 ml 9 %
LT. Vertical Slope Concave Type I 47 ml 91 % TOTAL GFR 51 ml / min. IMPRESSION: Features suggestive of Non- Functioning Rt. Kidney +. The comparison done with the previous scan RD / 4414 / 2002 reveals that the GFR has become 51 ml / min from the previous value of 46 ml / min.
DR.V.SIVASUBRAMANIYAN, Consultant , Nuclear Medicine Physician.
__________________________________________________________________________________
![Page 39: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/39.jpg)
![Page 40: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/40.jpg)
![Page 41: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/41.jpg)
![Page 42: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/42.jpg)
![Page 43: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/43.jpg)
![Page 44: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/44.jpg)
![Page 45: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/45.jpg)
![Page 46: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/46.jpg)
![Page 47: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/47.jpg)
Decrease in % of uptake by > 10%.
Reduction in GFR by > 10%
Worsening of renographic curves
Increased tracer retention
Increased transit time
POSITIVE CRITERIAS
![Page 48: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/48.jpg)
![Page 49: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/49.jpg)
Male : 16-68 yrs ; 36.1 +- 13 47
Female : 15-50 yrs ; 34.1 +- 9 16
Total 63
Captopril Series
![Page 50: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/50.jpg)
Results
Positive : 10 / 63 15%
Negative : 53 / 63 85%
![Page 51: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/51.jpg)
CAPTOPRIL STUDY
![Page 52: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/52.jpg)
![Page 53: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/53.jpg)
![Page 54: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/54.jpg)
![Page 55: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/55.jpg)
Negative Group
MALES
Pre 61 +/- 25 ml
Post 76 +/- 29 ml
FEMALES
65 +/- 29 ml
82 +/- 20
![Page 56: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/56.jpg)
FLOW CHARTHigh risk hypertensive
Color duplex doppler sonography
Renal artery stenosis
Positive Equuivocal Negative
Drug stoppage
Possible Not possible
PTRA Captopril Asprin Exr. renogram
![Page 57: Diuretic renography](https://reader033.fdocuments.net/reader033/viewer/2022061301/54d6213b4a79591c488b45b4/html5/thumbnails/57.jpg)
THANK YOU