title: The value of quantitative 99M technetium dimercaptosuccinic acid renal scintigraphy for predicting postoperative renal insufficiency in patients undergoing nephrectomy.
abstract: OBJECTIVE
  Radical nephrectomy is a routine urological practice. However, little is known about the use of dimercapto-succinic acid (DMSA) scan to evaluate compensatory changes after surgery and its ability to identify patient at risk for postoperative chronic renal failure or insufficiency. We predicted remaining kidney function using DMSA scan and serum creatinine.
  
  
  METHODS
  A total of 42 patients were enrolled in the study. All underwent DMSA scan before surgery and in 38 DMSA scan was done after unilateral nephrectomy. Serum creatinine was determined before and 1 year after surgery. The Student t test was used to determine statistical significance. Spearman rank core analysis was used to evaluate the association of calculated creatinine clearance time after surgery and renal absolute uptake before surgery. We performed 1-way ANOVA comparison of the means to determine the influence of age distribution on kidney hypertrophy and the increase in kidney uptake.
  
  
  RESULTS
  Average patient age was 61.5 years. Baseline mean creatinine clearance time was 71.5 ml. per minute, which decreased to 58.6 ml. per minute after nephrectomy (p <0.0001). Before surgery DMSA scan of the remaining kidney demonstrated an absolute uptake of 4.2% higher than that in the resected kidney (13.5% versus 9.35%, p = 0.0008). After nephrectomy the remaining kidney had an average increase of 3.9% of mean absolute uptake (17.7% versus 13.8%, p = 0.0001). Spearman rank core analysis demonstrated an association of higher preoperative absolute uptake in the remaining kidney with postoperatively high creatinine clearance time (r = 0.458, p = 0.003). Furthermore, 75% of patients with postoperative creatinine clearance time less than 40 ml. per minute presented with a preoperative absolute uptake of lower than 11% in the remaining kidney. In contrast, 75% of those with a postoperative creatinine clearance time of higher than 40 ml. per minute had a preoperative absolute uptake of higher than 11%.
  
  
  CONCLUSIONS
  A preoperative absolute uptake of lower than 11% in the remaining kidney was a significant risk factor for postoperative chronic renal insufficiency.
authors.affiliation: Department of Urology, Nuclear Medicine Unit, Bnai-Zion Medical Center, 47 Galomb Street, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Mullerad
authors.forename: Alexander
authors.initials: A
authors.lastname: Kastin
authors.forename: Elias
authors.initials: E
authors.lastname: Issaq
authors.forename: Boaz
authors.initials: B
authors.lastname: Moskovitz
authors.forename: David
authors.initials: D
authors.lastname: Groshar
authors.forename: Ofer
authors.initials: O
authors.lastname: Nativ
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects*; D019275:Radiopharmaceuticals; D051437:Renal Insufficiency / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D003404:Creatinine