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The use of renal scintigraphy with technetium-99m-L,L-ethylenedicysteine in critically ill patients with acute renal failure in the intensive care unit
Critical Care volume 7, Article number: P44 (2003)
Patients with acute renal failure (ARF) often represent a diagnostic challenge to physicians in the intensive care unit. A noninvasive test would be valuable to assist the clinicians in making differential diagnoses for these patients. Technetium-99m-L,L-ethylenedicysteine (99mTc-EC), a new renal radiopharmaceutical, provides high quality images in patients with renal failure and its clearance resembles that of hippuran, which makes it a desirable agent to evaluate tubular function, such as in patients with acute tubular necrosis (ATN). Adequate renal uptake seemed to predict recovery of renal function.
To evaluate the diagnostic value of 99mTc-EC renography in the diagnosis of acute renal failure in critically ill patients in an intensive care unit.
After the usual diagnostic approach, two patients were submitted to renal scintigraphy with 99mTc-DTPA and 99mTc-EC, and one patient to 99mTc-EC renal scintigraphy.
The first patient was hospitalized with hypertension and left renal abscess. She was submitted to left nephrectomy and evoluted to ARF, requiring hemodialysis. The 99mTc-EC renography showed normal flow to the right kidney, and delayed and decreased activity compatible with ATN. The clearance values of 99mTc-EC and 99mTc-DTPA were 28.4 ml/min and 6.1 ml/min, respectively. The hemodialysis was suspended and the 99mTc-EC clearance increased to 35 ml/min. The second patient had diabetes and hypertension, and was hospitalized with acute pulmonary edema. The 99mTc-EC renography showed decreased flow and uptake to both kidneys without any evidence of significant excretion into collecting systems. The findings were consistent with the clinical suspect of renal cortical necrosis. The clearance values of 99mTc-EC and 99mTc-DTPA were 16.9 ml/min and 9.4 ml/min, respectively. The patient required hemodialysis treatment. The third patient had myocardial infarction and evoluted to shock with ARF. The 99mTc-EC renography showed normal flow to both kidneys, and delayed and decreased activity compatible with ATN. The patient required hemodialysis. The clearance value of 99mTc-EC was 39 ml/min.
For patients with acute renal failure, the 99mTc-EC renal scan may facilitate decisions regarding the management of therapy. The use of the 99mTc-EC renal scan in the differential diagnosis of acute renal failure appears promising in the setting of the intensive care unit.
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Corrêa, P., Felix, R., Dutra, P. et al. The use of renal scintigraphy with technetium-99m-L,L-ethylenedicysteine in critically ill patients with acute renal failure in the intensive care unit. Crit Care 7, P44 (2003). https://doi.org/10.1186/cc2240
- Intensive Care Unit
- Acute Renal Failure
- Pulmonary Edema
- Normal Flow
- High Quality Image