Monitoring Renal Function: A Prospective Study Comparing Camera-Based Technetium-99m Mercaptoacetyltriglycine Clearance and Creatinine Clearance

The International Scientific Committee of Radionuclides in Nephro-urology (ISCORN; http://www.iscorn.org) began in the late 1960s as an independent group of physicians and scientists working to facilitate radionuclide renal research and the practice of renal nuclear medicine. This group has subsequently issued a series of Consensus reports and has now developed a Guidance Document for quality assurance and structured reporting of diuresis renography in adults. ISCORN chose diuresis renography for its first Guidance Document for several reasons: suspected obstruction is the most common reason for referral, most radionuclide renal studies are conducted at institutions that perform fewer than 3 studies per week, and a large percentage of radionuclide renal studies are interpreted by physicians with limited training in nuclear medicine. An additional rationale was the observation that diuresis renography reports from ISCORN member institutions showed marked variation in the elements included in the reports as well as considerable variation in how the results were communicated to the referring physicians. Reports that omit the essential components of the procedure, that lack the necessary elements required for quality assurance and interpretation, that fail to indicate the rationale supporting the conclusions, and that fail, in some cases, to even clearly state the conclusions are a disservice to patients and reflect badly on nuclear medicine and radiology. To address these concerns, this Guidance Document was developed through an iterative series of comments and questionnaires regarding the reporting structure and importance of specific elements in the report. Panelists were asked to categorize each element as essential, recommended but not essential, local option (possibly useful but without sufficient data to support a higher ranking), and unnecessary (does not contribute to quality assurance or scan interpretation). Each element was independently scored by panelists without access to the individual scores of the other members or knowledge of the identity of panel members making specific comments. A majority vote was required to place an element in a specific category. The Guidance Document recommends a reporting structure organized into indications, clinical history, study procedure, findings and impression. The Guidance Document also specifies the elements considered essential or recommended in each of the reporting categories and provides a brief discussion of specific elements. Few elements, however, achieved unanimous agreement and the panel recognizes the need for innovation and the possibility of constraints imposed by local circumstances. Consequently, the Guidance Document is not intended to be restrictive but rather to provide a basic structure and rationale for diuresis renography reports in adults so that a report: (1) communicates the results to the referring physician in a clear and concise manner designed to optimize patient care; (2) contains the essential elements required to evaluate and interpre...

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“…33 The creatinine clearance as a measure of Glomerular filtration rate suffers from a lack of accuracy and poor precision. 3,33,34 …”

Section: Resultsmentioning

confidence: 99%

Guidance Document for Structured Reporting of Diuresis Renography

Taylor

Blaufox

Palma

et al. 2012

Seminars in Nuclear Medicine

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“…Lastly, efficacy of dynamic renography radiopharmaceuticals such as 99m Tc-mercaptotriglycylglycine or 99m Tcdiethylenetriaminepentaacetic acid is not investigated. 99m Tc-mercaptotriglycylglycine clearance is reported to parallel creatinine clearance [11] or to be superior to the conventional creatinine clearance for monitoring changes in renal function [12] .…”

Section: Discussionmentioning

confidence: 99%

Decrease of Renal Function due to Warm Ischemia after Laparoscopic Partial Nephrectomy: Evaluation Using <sup>99m</sup>Tc-DMSA Renal Scintigraphy

Tachikake

Shigeta²,

Mita³

et al. 2009

Urol Int

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Introduction: The purpose of this study is, using technetium-99m-dimercaptosuccinic acid (^99mTc-DMSA), to evaluate the decrease of renal function caused by warm ischemia. Patients and Methods: The ^99mTc-DMSA scan was performed before and 1, 3 and 6 months after the operation for 19 consecutive patients. The patients were divided into three groups by warm ischemic time (group A: ≤40 min, B: >40 min ∩ ≤60 min, C: >60 min). Renal function of the unresected part was defined as the uptake to unresected part relative to the uptake to the contralateral kidney. The reduction of renal function was expressed as a ratio of the function after the surgery divided by function before the surgery and was compared between the three groups. Results: The reduction in group C after 1 and 3 months tended to be greater than that in group A or B, although not reaching statistical significance (one-way ANOVA test, 1 month: p = 0.15 and 3 months: p = 0.13). There was a significant difference in reduction of renal function between the three groups after 6 months (one-way ANOVA test, p = 0.02). The Scheffé test showed a statistical significance between groups A and C (p < 0.05). Conclusion: Renal function calculated by ^99mTc-DMSA shows that prolonged ischemic time causes significant damage to the kidney.

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“…The percentage injected dose is converted to a clearance measurement using a validated nomogram (67). Camera-based clearances appear to be reproducible and are superior to creatinine clearance for monitoring changes in renal function (68). Although camera-based clearances are considered to be less accurate than plasma sample clearances (3), they avoid sources of error (timing of plasma samples, correction for radioactive decay, dilution of standards, pipetting small volumes) inherent in plasma sample techniques.…”

Section: Quantitative Indicesmentioning

confidence: 99%

Radionuclides in Nephrourology, Part 1: Radiopharmaceuticals, Quality Control, and Quantitative Indices

2014

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Radionuclide renal scintigraphy provides important functional data to assist in the diagnosis and management of patients with a variety of suspected genitourinary tract problems, but the procedures are underutilized. Maximizing the utility of the available studies (as well as the perception of utility by referring physicians) requires a clear understanding of the clinical question, attention to quality control, acquisition of the essential elements necessary to produce an informed interpretation, and production of a report that presents a coherent impression that specifically addresses the clinical question and is supported by data contained in the report. To help achieve these goals, part 1 of this review covers information that should be provided to the patient before the scan, describes the advantages and limitations of the available radiopharmaceuticals, discusses quality control elements needed to optimize the study, summarizes approaches to the measurements of renal function, and focuses on recommended quantitative indices and their diagnostic applications. Although the primary focus is the adult patient, aspects of the review also apply to the pediatric population.

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Monitoring Renal Function: A Prospective Study Comparing Camera-Based Technetium-99m Mercaptoacetyltriglycine Clearance and Creatinine Clearance

Abstract: The results of this study have demonstrated that MAG3 clearance obtained using a camera-based technique shows greater precision than the conventional creatinine clearance and is superior to the conventional creatinine clearance for monitoring changes in renal function.

Cited by 14 publications

References 15 publications

Guidance Document for Structured Reporting of Diuresis Renography

Guidance Document for Structured Reporting of Diuresis Renography

Decrease of Renal Function due to Warm Ischemia after Laparoscopic Partial Nephrectomy: Evaluation Using <sup>99m</sup>Tc-DMSA Renal Scintigraphy

Radionuclides in Nephrourology, Part 1: Radiopharmaceuticals, Quality Control, and Quantitative Indices

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