Reversible diminished renal 99mTc-DMSA uptake during converting-enzyme inhibition in a patient with renal artery stenosis.
A patient is described who had accelerated hypertension and unilateral renal artery stenosis, and who developed further deterioration in renal function during treatment with captopril, an angiotension-I (AI) converting-enzyme inhibitor. 99mTc-DMSA uptake was greatly diminished in the stenotic kidney, although renal blood flow and handling of 131I-hippurate was preserved. Uptake of 99mTc-DMSA in the affected kidney returned after substitution of captopril by the vasodilator minoxidil, while a comparable degree of blood pressure control was maintained. Thus, caution must be taken when interpreting results of 99mTc-DMSA scintigraphy in patients with proven or suspected renal artery stenosis treated with an AI converting-enzyme inhibiting drug. Moreover, our finding points to the importance of glomerular filtration in the renal handling of 99mTc-DMSA.
D000806:Angiotensin-Converting Enzyme Inhibitors; D002216:Captopril / Q000494:pharmacology / Q000627:therapeutic use; D005919:Glomerular Filtration Rate; D006801:Humans; D007457:Iodine Radioisotopes; D007465:Iodohippuric Acid; D007668:Kidney / Q000000981:diagnostic imaging / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging* / Q000201:enzymology / Q000378:metabolism / Q000503:physiopathology; D004113:Succimer; D013667:Technetium; D019783:Technetium Tc 99m Dimercaptosuccinic Acid
D000806:Angiotensin-Converting Enzyme Inhibitors; D007457:Iodine Radioisotopes; D007465:Iodohippuric Acid; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D013667:Technetium; D002216:Captopril; D004113:Succimer