Diuretic renography in hydronephrosis: delayed tissue tracer transit accompanies both functional decline and tissue reorganization.
The significance of delayed tissue tracer transit (TTT) of (99m)Tc-mercaptoacetyltriglycine ((99m)Tc-MAG3) has not been systematically evaluated in hydronephrosis. We sought to demonstrate that delayed TTT accompanies both functional decline and histomorphologic restructuring.


METHODS
Twenty 2- to 3-mo-old piglets with surgically induced partial unilateral ureteral stenosis were examined with magnetic resonance urography (MRU) to evaluate morphology and with (99m)Tc-MAG3 diuretic renography (DR) to determine single-kidney function (SKF), evaluate the response to furosemide stimulation (RFS), and assess TTT. All animals had DR and MRU before and after surgery and a third DR after surgery. Piglets were sacrificed after the final DR for renal histology. A total histologic score (THS) was generated.


RESULTS
Preoperative DR demonstrated nonobstructive RFS, timely TTT, and balanced SKF in all 20 kidneys. After ureteral ligature, MRU demonstrated pelvic dilatation in all piglets. The postoperative DRs revealed 12 kidneys with delayed TTT in one or both follow-ups. In these 12 kidneys, the SKF declined from 51% +/- 4% to 18% +/- 14%, and the THS was 9.0 +/- 4.0. Three kidneys always had timely TTT, balanced SKF, and a THS of 1.8 +/- 0.3. The contralateral, nonoperated kidneys had timely TTT and a THS of 1.2 +/- 0.9. Postoperative scintigrams showed that 3 of 8 kidneys (38%) with an obstructive RFS had timely TTT, which demonstrates that TTT and RFS are not equivalent.


CONCLUSIONS
In hydronephrosis, a delayed TTT of (99m)Tc-MAG3 accompanies both functional decline and histomorphologic restructuring in obstruction. According to the literature, a delayed TTT is determined by the filtration fraction of the kidneys and appears to identify an obstruction-mediated upregulated renin-angiotensin system.
Department of Nuclear Medicine, University Hospital Freiburg, Freiburg, Germany. Andreas.Schlotmann@Uniklinik-Freiburg.de
Andreas
A
Schlotmann
John H
JH
Clorius
Wiltrud K
WK
Rohrschneider
Sandra N
SN
Clorius
Folker
F
Amelung
Kristianna
K
Becker
D000818:Animals; D001693:Biological Transport, Active; D004232:Diuretics / Q000627:therapeutic use; D005665:Furosemide; D006869:Hydronephrosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D007668:Kidney / Q000000981:diagnostic imaging / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D011866:Radioisotope Renography; D019275:Radiopharmaceuticals; D013552:Swine; D017263:Technetium Tc 99m Mertiatide
D004232:Diuretics; D019275:Radiopharmaceuticals; D017263:Technetium Tc 99m Mertiatide; D005665:Furosemide