The focus of this review is on the current role of nuclear imaging studies in the clinical evaluation of patients with acute and chronic renal failure. In this setting nuclear imaging has two roles: diagnostic and prognostic, indicating that these methods are an essential component in the evaluation of renal diseases. The functional assessment of the kidney by nuclear medicine procedures is based on the use of radioisotopes bound to non-metabolized molecules with known pharmacokinetics. Renal scintigraphy is usually applied for the assessment of renal function expressed as glomerular filtration rate, effective renal plasma flow or more generally kidney perfusion. Newer methods rely on positron emission tomography, which allows the generation of images with higher resolution and absolute quantitation of biological processes such as transport activities, enzyme activities or angiotensin receptors.

We conducted a single-arm study to determine the biodistribution of intraperitoneally (i.p.) administered 90yttrium-labeled murine monoclonal antibody HMFG1 (90Y-muHMFG1) in patients with advanced stage ovarian cancer. Seventeen (17) patients in complete clinical remission for epithelial ovarian cancer were included. After completion of chemotherapy, a mixture of 111indium-labeled muHMFG1 (imaging) and 90Y-muHMFG1 (therapy) was i.p. administered by a surgically placed, indwelling i.p. catheter. Planar and single-photon emission computed tomography images were recorded to determine the distribution of the study medication during the first 6 days postinjection. Of the first 3 patients, 2 patients had extraperitoneal leakage of up to 50% of the injected dose within 24 hours after injection of the study medication. Extraperitoneal leakage was mainly seen in the retroperitoneal spaces covering the upper and lower quadrant of the abdomen. After adjustments in the procedure, leakage was observed in 2 of the remaining 14 patients. Extraperitoneal leakage of i.p. administered therapy does occur. Such leakage would reduce the locally delivered dose of a drug and could potentially have a negative impact on therapeutic efficacy. Given the potential attraction of developing i.p. treatments for intra-abdominal cancer, the observations in this study need to be taken into consideration.