Impact of renal scintigraphy in severe patients with acute renal failure

Introduction

Acute renal failure (ARF) is frequent in severe patients, producing a poor outcome in the face of its multiple insults that are individually determined [1, 2]. Technetium 99m ethylenedicysteine scintigraphy (Tc-EC) has a very low plasma protein binding and a large volume of distribution. Tc-EC is a good agent for renal function evaluation, providing an index of tubular function and yielding high-quality images [[3–5]].

Objective

To evaluate the clinical impact of renal scintigraphy (RC) in the management of ARF.

Materials and methods

We evaluate all patients in ICUs of a general, private hospital, submitted to RC in the period of January 2003 to January 2004.

Results

Thirty-four patients (18 male), 79.56 ± 16.26 years old, with an APACHE II score of 16.94 ± 6.34 (expected mortality 25%) were studied. The observed mortality was 29.41%. Seventy-three percent of the patients were anuric for 55.36 ± 13.43 days. Dialyses were used in 85.29% of the population and RC always carried through after 30 days. Seventy-four percent of the patients were mechanically ventilated during RC with no transport accident. RC changed the nephrology prescription, interrupted the method or indicated long-term access confection. The radiotracer most used was Tc-EC in 64.70% of the patients. Twenty percent of the patients continued in chronic dialysis and 17.64% had recovered renal function.

Conclusion

RC, mainly with Tc-EC, influenced and modified the clinical impression, nephrological decision, and medical care of severe ARF patients. RC seems to be a good cost-benefit with simple accomplishment method to evaluate glomerular filtration and tubular function with an important impact especially in anuric patients.