Positron emission tomography: a new method for determination of renal function.
Positron emission tomography (PET) is a newly evolving diagnostic modality that has been widely used in many facets of clinical medicine, but whose use in the diagnosis and management of disorders of the kidney has not been previously described. Employing the radiotracer N-13 ammonia, flow-dependent extraction of this compound after intravenous injection was used to measure renal blood flow (RBF) in a swine model (N = 10). A mean baseline value of 3.16 ml./min./gm. kidney was obtained with this method, in close agreement with values previously reported using established invasive techniques. Four conditions known to affect RBF were also studied to determine the ability of PET to detect changes in RBF. Kidneys were subjected to varying durations of warm ischemia, demonstrating a progressive decrease in RBF with increasing ischemic insult, with return to normal significantly impaired in animals exposed to the greatest degree of ischemia (180 minutes versus 150 or 120 minutes ischemia). Cross-transplant between animals produced acute allograft rejection and a corresponding marked decrease in RBF that failed to normalize. After unilateral nephrectomy, RBF increased two-fold in the remaining kidney by 7 days (R = 0.79), as predicted for compensatory renal hypertrophy. Lastly, there was an inverse, linear relationship between toxic cyclosporine level and RBF (R = 0.68), indicative of vascular-mediated cyclosporine nephrotoxicity. Positron emission tomography is safe and efficient, and yields an accurate measurement of RBF in several important physiologic states. The development of PET as a quantitative measure of renal function is promising.
Killion
D
D
Division of Urology, University of California, Los Angeles.
Nitzsche
E
E
Choi
Y
Y
Schelbert
H
H
Rosenthal
J T
JT
D000818:Animals; D005260:Female; D007668:Kidney / Q000098:blood supply*; D007677:Kidney Function Tests; D012039:Regional Blood Flow; D013552:Swine; D014055:Tomography, Emission-Computed