radionuclide studies in renovascular hypertension (rvh) in
TRANSCRIPT
![Page 1: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/1.jpg)
http://humanhealth.iaea.org
Radionuclide Studies in Renovascular Hypertension (RVH)
in Paediatric Population
Isabel RocaHU VALL HEBRONBarcelona, Spain
![Page 2: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/2.jpg)
basal captopril
basal captopril
![Page 3: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/3.jpg)
http://humanhealth.iaea.org
Method Pros Cons
Doppler ultrasound• Reasonable cost• Wide availability• No ionizing radiation
• Operator-dependent• Many non-diagnostic studies
Angio MRI• Useful to separate responders from non-responders• No ionizing radiation
• Low resolution (small vessels)• Motion artifacts, stents
Captopril MRI• No nephrotoxic contrast media• Pacient with renal failure• No ionizing radiation
• High cost• Limited availability• Low PPV
Renovascular HypertensionImaging Studies
![Page 4: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/4.jpg)
http://humanhealth.iaea.org
Method Pros Cons
Angio CT
• High spatial resolution• Shows calcium content• No stent artifacts• Measures cortical thickness and renal size
• Nephrotoxic contrast media• High dosimetry• Ppoor visualization small vessels
Captopril Renography
• Reasonable cost• Identifies responders• High NPV
• Low resolution (small vessels)• Motion artifacts, stents
Renal Angiography• “Gold standard” for renal artery stenosis• Less contrast volume if digital subtraction is used
• Nephrotoxic contrast media• High dosimetry• Interobserver variability
Renovascular HypertensionImaging Studies
![Page 5: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/5.jpg)
http://humanhealth.iaea.org
Renovascular HypertensionPathophysiology
Reduced perfusion of affected kidney
Renin-angiotensin system is activated
Releasing:- angiotensin II
vasoconstriction- aldosterone
plasma expansion
Renal artery stenosis
Attempting to preserve / increase renal blood
pressure
![Page 6: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/6.jpg)
http://humanhealth.iaea.org
DETECTED THROUGH FUNCTIONAL STUDIES
FUNCTIONAL DETERIORATIONof stenotic kidney
PHARMACOLOGICBLOCKADE
of activated renin-angiotensin system
REVERSIBILITY
• greater in initial phase• predicts a good response to revascularization
• Renogram: MORPHO-FUNCTIONAL• Information on reversibility ofarterial lesion
Renovascular HypertensionPathophysiology
![Page 7: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/7.jpg)
http://humanhealth.iaea.org
NON-REVERSIBLEHIPERTENSION
AFTER REVASCULARIZATION(DILATION OF STENOTIC
ARTERY)
Hipertensión renovascularFase crónica
“FIXED”HIPERTENSION
PHARMACOLOGIC BLOCKADE
less effective
Renovascular HypertensionChronic Phase
![Page 8: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/8.jpg)
http://humanhealth.iaea.org
Renal Angiography
-“Gold standard ” for diagnosis of RVH.- Detects anatomic changes in renal arteries.- Does not inform about:
- functional changes - reversibility of the lesion
![Page 9: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/9.jpg)
http://humanhealth.iaea.org
en caso de HTA con estenosis reversible de la arter ia renal• disminución del filtrado glomerular del riñón afecto y • aumento del tiempo de tránsito renal del trazador
- Well standardized technique- Neds comparison of :
- basal vs.- post-captopril renography
CAPTOPRIL:- disminuyendo la VC de la arteriola eferente post-glomerular- evita la conversión de angiotensina I a angiotensina II
basal captopril
Captopril Renography
![Page 10: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/10.jpg)
http://humanhealth.iaea.org
• withdraw ACE inhibitors � 5-7 days before the study
• temporarily suspend diuretics • temporarily suspend calcium channel blockers
• The technique is applicable to patients� with one kidney� with renal transplantationBut a captopril dose adjustment is needed
Captopril RenographyPatient Preparation
![Page 11: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/11.jpg)
http://humanhealth.iaea.org
PREPARATION• Hydration
• Micturition
• 0.25 mg /kg furosemide intravenous at minutes 0 (to avoid ectasia in excretory pathways)
• Withdraw ACE inhibitors• Withdraw, if possible, diuretics and calcium blockers
Captopril RenographyTechnique
![Page 12: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/12.jpg)
http://humanhealth.iaea.org
CAPTOPRIL
� Administration of captopril orally (or intravenously) 60 minutes before the study
� Typical dose:� 50 mg adults - 25 mg in single kidney� dose weight adjusted
� BP and HR monitoring: at least 2 determinations � Before administration of captopril� before the start of the renogram
Captopril RenographyTechnique
![Page 13: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/13.jpg)
http://humanhealth.iaea.org
LIMITATIONS• Low or very low function of affected kidney • Transient decrease in glomerular filtration rate secondary to
� Intravenous injection of contrast (CT angiography)� On the preceding 2 weeks� Both ionic and non-ionic contrast
RADIOPHARMACEUTICALS AND TECHNIQUE• Adults and children
� DTPA or MAG3 renogram• Infants and young children and in cases of suspected pathology of a polar artery
� DMSA renal scan
Captopril RenographyTechnique
![Page 14: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/14.jpg)
http://humanhealth.iaea.org
123I-OIH
99mTc-EC
99mTc-MAG3
123I-OIH
99mTc-DMSA99mTc-GH
99mTc-DTPA
![Page 15: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/15.jpg)
http://humanhealth.iaea.org
RENOGRAM99mTc-DTPA99mTc-MAG3
• ↓ function• ↑ transit time• cortical tracer retention
CORTICAL SCINTIGRAPHY99mTc-DMSA
• ↓ function� diffuse� focal
Captopril RenographyInterpretation: Basal vs. Captopril comparison
basal captopril
Positive findings:
![Page 16: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/16.jpg)
http://humanhealth.iaea.org
RENOGRAM • RK• LK
� preserved function and excretion bilaterally post-captopril
RENOGRAM• RK• LK
� Functional drop inferior half LK post-captopril
basal captopril
basal captopril
![Page 17: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/17.jpg)
http://humanhealth.iaea.org
CAPTOPRIL RENOGRAM• RK• LK: focal area with prolonged transit time
BASAL RENOGRAM • RK• LK
� preserved function and excretion bilaterally post-captopril
![Page 18: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/18.jpg)
http://humanhealth.iaea.org
Digital subtracton angiography:• Multiple small aneurysms associated with irregularities of medial and inferior polar arteries.• Focal stenosis >70% subsegmental artery.
![Page 19: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/19.jpg)
http://humanhealth.iaea.org
basal
captopril
Left renal artery stenosis
![Page 20: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/20.jpg)
http://humanhealth.iaea.org
![Page 21: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/21.jpg)
http://humanhealth.iaea.org
Renal cortical scintigraphy with 99mTc-DMSA • Focal reduced uptake • Polar artery stenosis
basal captopril
![Page 22: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/22.jpg)
http://humanhealth.iaea.org
basal captopril
ANGIOGRAPHY
normal abnormal
DMSA(basal)
normal 4 4
abnormal 5 7
DRF<45% or focal defect
SENSITIVITY 64%
SPECIFICITY 44%
![Page 23: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/23.jpg)
http://humanhealth.iaea.org
basal captopril
ANGIOGRAPHY
normal abnormal
DMSA(captopril)
normal 4 1
abnormal 4 10
SENSITIVITY 91%
SPECIFICITY 50%
DRF<45% or focal defect
![Page 24: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/24.jpg)
http://humanhealth.iaea.org
RENOGRAM:LK functional cancellation
ANGIOGRAPHY:Left renal artery stenosis
![Page 25: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/25.jpg)
http://humanhealth.iaea.org
ANGIOGRAPHY• RA stenosisCAPTOPRIL RENOGRAPHY
• Chronic renal failure• Right K = 10%
![Page 26: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/26.jpg)
http://humanhealth.iaea.org
basal captopril
![Page 27: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/27.jpg)
http://humanhealth.iaea.org
basal captopril
RENAL TRASPLANT • max 25 mg captopril• captopril:
• ↓↓↓↓ function• ↑↑↑↑ transit time• ↓↓↓↓ excretion
![Page 28: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/28.jpg)
http://humanhealth.iaea.org
Renovascular disease
Radionuclide Renography• basal• captopril
99MTc-DTPA
![Page 29: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/29.jpg)
http://humanhealth.iaea.org
Basal
![Page 30: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/30.jpg)
http://humanhealth.iaea.org
Captopril
![Page 31: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/31.jpg)
http://humanhealth.iaea.org
Post revascularization
![Page 32: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/32.jpg)
http://humanhealth.iaea.org
45%55%
46%54%
![Page 33: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/33.jpg)
http://humanhealth.iaea.org
44%56%
37%63%
![Page 34: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/34.jpg)
http://humanhealth.iaea.org
32%68%
22%78%
![Page 35: Radionuclide Studies in Renovascular Hypertension (RVH) in](https://reader031.vdocument.in/reader031/viewer/2022012412/616c6f203ab8b10b5f12ed6a/html5/thumbnails/35.jpg)
http://humanhealth.iaea.org
Captopril renography is a morpho-functional technique
envolving low irradiation which gives information about
renovascular lesions as well as an estimation of potential
lesion reversibility, predicting treatment response.
Captopril RenographyConclusion