Scintigraphic Skeletal Changes in Uremic Patients on Regular Hemodialysis

Abstract

⁹⁹Tc^m-polyphosphate (Tc-PP) bone scintigraphy was performed in 30 consecutive uremic patients on regular hemodialysis and compared with a normal control group. 27 of the patients (90%) had pathological accumulation on the scintigrams, while roentgenographic abnormalities were present in only 10 patients (33%), indicating that scintigraphy is superior to X-ray in the early detection of skeletal changes in uremic patients. In the group with the most pronounced uptake on the scintigrams there was a preponderance of previously kidney-transplanted patients, while no correlation could be demonstrated between the severity of the scintigraphic findings and the duration of the hemodialysis period, the anephric state of the patients, the underlying kidney disease or the sex. It is suggested that intensive glucocorticoid treatment, even of short duration in the previously kidney-transplanted patients, may aggravate uremic osteodystrophy.

Osteoscintigraphic Changes in Kidney-Transplanted Patients

“…Increased pulmonary uptake of the tracer was found in 11 of the 105 kidney-transplanted patients corresponding to the 10% demon strated in patients on chronic hemodialysis [15]. It has been suggested that this finding reflects pulmonary calcification [2,7,10,13,19,20], In the present investigation no patients showed radiographic evidence of calcification of the lungs.…”

“…Il has further been suggested that the complexes are attached to the free aldehyde groups of the collagen molecule [3.22,23], Thus the Tc-PP scinti graphy in the evaluation of metabolic bone disease is not specific and should be supple mented with other investigations to secure the diagnosis of the bone lesion. Nevertheless, Tc-PP scintigraphy applied to metabolic bone disease has recently been shown to be of signi ficant importance [11,15,21,22], In a previous investigation [15] 90% of hemodialysis patients showed scintigraphic signs of generalized bone disease. In the pre sent investigation on kidney-transplanted pa tients only 49% had generalized scintigraphic changes, demonstrating that renal osteodys trophy is less frequent after a kidney trans plantation.…”

“…This may reflect that either prednisone and/or other factors contributing to the results of the transplantation induce generalized changes in distinguishable by scintigraphy from renal osteodystrophy. The role of prednisone in the development of generalized changes is sup ported by the previously demonstrated cor relation between the severity of generalized scintigraphic changes in dialysis patients and the total dose of prednisone during a previous short-lasting unsuccessful kidney transplanta tion [15].…”

“…Details were as previously described [9,15]. Recti linear whole body scintigraphy was performed 2 h after intravenous administration of 12 mCi Tc-PP.…”

“…In a previous investigation [15] we reported on the applicability of technetium-99m-polyphosphate (Tc-PP) scintigraphy in the evalu ation of osteodystrophy in patients on regular hemodialysis.…”