title: Significance of technetium-99m human serum albumin diethylenetriamine pentaacetic acid scintigraphy in patients with nephrotic syndrome.
abstract: It is thought that a large amount of albumin leaking from the glomerulus in nephrotic syndrome (NS) is reabsorbed at the proximal tubule and catabolized. Therefore, it is possible the final quantity of urinary protein does not always reflect the amount of leakage of protein from the glomerulus. We experienced two cases without nephrotic range proteinuria thought to involve hypoproteinemia due to the same pathophysiology as NS. On these patients, we performed protein leakage scintigraphy with technetium-99m human serum albumin diethylenetriamine pentaacetic acid (99mTc-HSAD) to exclude a diagnosis of protein-losing gastroenteropathy and observed diffuse positive accumulation in the kidneys with more intense uptake in the kidney than the liver on the anterior view 24 hours after 99mTc-HSAD administration. In healthy adults intravenously given 99mTc-HSAD, the same dynamics are observed as in albumin metabolism, and the organ radioactivity of the liver and kidneys after 24 hours is equal. Therefore, we thought it was possible that the renal uptake 24 hours after 99mTc-HSAD administration was a characteristic finding of NS. In order to confirm it, the subjects were divided into two groups: the NS group (n = 10) and the non-NS group (n = 7). We defined more intense uptake in the kidney than the liver on the anterior view 24 hours after 99mTc-HSAD administration as Dense Kidney (+). Furthermore, we designed regions of interest in the right and left kidneys and liver on anterior and posterior images, then calculated the kidney-liver ratio. Nine of the ten patients had Dense Kidney (+) in the NS group, compared to none in the non-NS group. And the kidney-liver ratio was significantly higher in the NS group than in the non-NS group on each view in the bilateral kidneys. In conclusion, our results suggest that the renal uptake 24 hours after 99mTc-HSAD administration is a characteristic finding of NS.
authors: Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan.
authors: Tsuyoshi
authors: T
authors: Takashima
authors: Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan.
authors: Tomoya
authors: T
authors: Kishi
authors: Department of Nephrology, Ureshino Medical Center, Ureshino, Japan.
authors: Koji
authors: K
authors: Onozawa
authors: Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan.
authors: Shuichi
authors: S
authors: Rikitake
authors: Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan.
authors: Motoaki
authors: M
authors: Miyazono
authors: Department of Radiology, Saga University Faculty of Medicine, Saga, Japan.
authors: Takateru
authors: T
authors: Otsuka
authors: Department of Radiology, Saga University Faculty of Medicine, Saga, Japan.
authors: Hiroyuki
authors: H
authors: Irie
authors: Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan.
authors: Ryuichi
authors: R
authors: Iwakiri
authors: Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan.
authors: Kazuma
authors: K
authors: Fujimoto
authors: Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan.
authors: Yuji
authors: Y
authors: Ikeda
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging / Q000379:methods*; D012189:Retrospective Studies; D013668:Technetium Tc 99m Aggregated Albumin; D016284:Technetium Tc 99m Pentetate
chemical_list: D013668:Technetium Tc 99m Aggregated Albumin; D016284:Technetium Tc 99m Pentetate