The Diagnostic value of DTPA Renal Scintigraphy in Diagnostic Kidneys Function - Research Paper Example

The Diagnostic value of DTPA Renal Scintigrapghy in Diagnostic Kidneys Function 1.0 Introduction Diethylenetriamine pentacetic acid (DTPA) is a medical radioactive scan procedure used in testing functionality of the kidneys and checking whether the problem causes obstruction of urine flow in the ureters/ bladder (NY publications, 2011). DTPA is also used in checking blood circulation in the kidney arteries as well as the reflux of urine back into the ureters from the bladder. DTPA is always considered as an excellent test follow- up to check on improvements especially after undergoing a specific kidney treatment. Alongside this, more modalities can be used in performing this scan. They include renal ultrasound, CT scan urography and Intravenous urography (IVU). Thus, this study is targeting to establish the Diagnostic value of DTPA renal scintigrapghy when diagnosing kidney functions. After development of dilatation on intravenous pyelography/ ultrasonograpghy during follow-up of undergoing renal transplantation, it is always necessary to distinguish between dilatation due to obstruction from the dilatation without obstruction (Silverstein, 2012). DTPA scintigrapghy is often used in the diagnosis of a condition known as hydronephrosis that is caused by abnormality in the function of the pyeloureteric junction. During renal transplantation, this test is normally used less frequently. The task of evaluating the state of deterioration in the renal functions after transplant is normally very difficult to assess, hence there is need to use the DTPA procedure (Meyers 2012). The use of DTPA scan entails many details that can offer credible information in regards to this phenomenon. 2.0 Literature review: The focus of this study is basically on the diagnostic value of DTPA Renal Scintigrapghy in diagnosing kidney functions. The functions of the kidneys involve filtering of blood to remove waste substances like urea and excess salt from the body (Thomas et al, 2009). This fluid is normally collected and discharged out of the kidneys through ureters that link the kidneys to the bladder. The top part of the ureter is known as renal pelvis and it joins the ureters with the kidneys. In nuclear medicine, during renal scans, the normal images expected show the delivery of fluids to the kidneys through the blood flow, then concentration of waste products in the kidneys and finally excretion into the bladders through the ureters. Nuclear medicine renal scan can be applied by using two different substances; these are the DTPA or the MAG3. The DTPA is a radiopharmaceutical procedure used in renal scan, however, in some cases the nuclear medicine specialist may decide to use MAG3. These two are known to be similar but MAG3 is known to give better quality images as compared to DTPA. Therefore, this is most useful when dealing with young children and patients who are suffering from extremely poor kidney functionality. A DTPA scan is done to check on the blood supply as well as the functioning and excretion of urine out of the kidneys (Abdulsamea 2010) The DTPA renal scan may also be carried out to evaluate the function and perfusion of the renal tubular. This procedure entails study on the manner in which the body fluids flow through the kidneys. The scan may also be done to check for renovascular hypertension; this is the form of high blood pressure that occurs in the arteries of the kidneys. They need to be checked to know the certainty of their performance and the level of perfection in carrying out their functions. Consequently, renal artery stenosis can also be checked through the DTPA scan. This is a condition where the arteries carrying blood to the kidneys are narrowed hence they cannot deliver optimally. Other functions of this DTPA scan involve checking of renal tubular obstruction; this involves checking for any blockages in the ureters or any other form of interruption. Finally, it can be used in assessing a patient’s condition after undergoing a renal transplant; the scan is used in determining the progress of the patient’s recovery in terms of the kidney performance as well as level of functionality (Kempi 2010). Below is a sample image of DTPA scan: Source: (Kempi, 2010) During the DTPA scan, the patient is made to lie on the scanning bed and the gamma camera placed under the bed/ over the patient. During this test, patients are normally required to be calm and avoid any form of movement to prevent any interference of the resulting images. Movements during the scan may result in blurred images that may not be easy to interpret. The process is painless to the patient, and is normally carried out by a qualified nuclear medicine specialist. One of the best things about this DTPA scan is that it has no side effects (Kempi 2010). Only in cases where a dose of diuretic is given will the patient experience frequent urination. Diuretics cause an increased flow of urine; it is used in making the kidney release more urine into the bladders and hence more frequent urination. The process takes between 30- 60 minutes depending on individual’s rate of kidneys functionality; this normally varies from person to person (Jeon et al 2010) The risk of process is free; however, patients need to inform doctors about their medical conditions prior to the exercise to prevent any form of overreaction to the medications used during the scanning process. This test involves the use of a small ionizing radiation dose, which is commonly used in various imaging tests (Steinbock 2010). After the scan, a patient will have sufficient information about functionality, blood supply and excretion of urine from the kidneys. The scan also makes it simple for doctors to assess how each of the kidneys function and find out the total percentage each contribute towards overall performance. DTPA scan consolidates all the information regarding this and presents them in a visual manner to enable doctors to predict or control any medical condition that is likely to happen or that is happening (Jeldres 2009) 3.0 Comparisons of DTPA scan to other imaging modalities Besides DTPA, there are other imaging modalities that can be used. These involve renal ultrasound, CT scan urography and Intravenous urography (IVU). 3.0.1 Renal ultrasound Renal ultrasound refers to a noninvasive procedure that is normally used in assessing the shape, size and the location of the kidneys. The use of ultrasound technology ensures quick visualization of kidneys and other internal related structures (Bates 2011). In other cases, ultrasound may be used in assessing blood flow to the kidneys. Renal ultrasound utilizes a transducer when performing its functions. It is handheld, and normally used in sending ultrasound waves at very high frequencies. After placing the transducer on the abdomen, ultra sound waves are moved through the various body organs and tissues. The waves bounce off these organs in form of echo and then go back to the transducer. Transducer then converts the reflected waves into pictures and images of the organs (Goldberg et al 2010). The results are then used in making up final compilation of the existing medical condition. Below is an image of renal ultrasound The transducer is capable of evaluating the direction and speed of blood flow within the vessels; just by sending the ultrasound waves and receiving feedbacks, the specialists can easily recognised an existing problem. Faintness or absence of these sounds may be an indication of no blood flow or obstruction (Winthrop Chemical Co. 2009). Renal Ultrasound is safe and can be used by pregnant women as well since it requires no radiation dyes to make them effective. Most similarities noted between the DTPA scan and the renal ultrasound scan is in their objectives. Both of these methods aim at evaluating the performance of the kidneys by checking the functionality levels of each of the various parts (Tempkin 2009). Similarly, they measure the velocity and direction of blood flow hence can be used to determine the presence of any obstruction in the renal system. The underlying difference between these two is in the DTPA that focuses on rather deeper details as opposed to ultrasound. In addition, due to the medications used before DTPA scan, pregnant women may not comfortably utilize these services, specialists argue that these can interfere with lactation. In Renal ultrasound, however, no medication is required, hence making it simple to use by everyone (Meltem et al 2008) 3.0.2 Intravenous urography (IVU) Intravenous urography, also recognized as intravenous pyelography is a procedure used in assessing problems relating to the kidneys, bladder, ureters and urethra using x-ray. When using the ordinary x-ray pictures, the urinary tract is always not clearly visible. However, with the use of intravenous urography, a contrast dye is applied to make the images more clear and easy to distinguish (Moreau 2012). The dye is injected into one of the veins, it then travels into the blood stream and concentrates in the kidneys. The dye used here blocks the X-rays hence making the kidneys, bladder and ureter to show up clearly for examination. As a result, the images produced here are clear and easy to read. Below is a sample image for Intravenous urography (IVU) (Tullus et al 2008) Intravenous urography (IVU) can be used in assessing a wide range of problems. These may include the following; Checking for kidney stones; IVU is highly sensitive and can easily detect the presence of a stone in the kidneys, ureters or bladder (Moreau 2012). The x-ray will merge the images. It can also be used in detecting urinary infections. This is a case of a recurring or prevailing infection in the urinary tract. IVU can help in establishing these by highlighting the major areas that experience blockages or any other form of abnormalities within the renal system (Viprakasit 2012). It can also be used to assess the reason for blood in the urine. Blood in the urine can always come as a result of inflammation, infection or tumor in the kidney. Intravenous urography (IVU) can be used in highlighting the areas with such problems and finding the right solutions, whether in the kidneys, the ureter or the bladder (Mancini &Ferrandino 2010) Similarly, a damaged part or obstruction of any form can be easily revealed by the intravenous urography (Mark et al 2007) Some of the similarities that exist between the intravenous urography and DTPA scan may include the following: Both the modalities check for problems related to kidneys, bladders and ureters. Their main objectives are to check on the levels of functionality of the kidneys and any obstruction that may exist (Lamb et al 2008) Both the DTPA scan and intravenous urography IVU can scan for infections in these major organs and then highlight its main cause or source. Some of the threats that patients may face include the following: The dye used in the x-ray process may cause a flushing or a warm feeling in the vein and taste in the mouth (Steinbock 2012). These pains however normally disappear fast. Some people may develop allergy to the dye used in the process. This may result in an itching rash and some mild swelling, but they normally go away fast, allowing the patient to recover as soon as possible (Zilberman 2011) Acute kidney failure may also show up after this process though it is a very rare condition. (Ferrandino et al 2009) 3.0.3 Computer tomography (CT scan urography) Computer tomography scans make use of X-rays to create detailed pictures of the organs inside the body. When taking the test, patients are made to lie on a table attached to the scanner (Forster et al. 2012). The scanner then sends the X-rays to the body area under study. Every rotation of the scanner brings a thin slice layer of the organ. The pictures are then saved on the computer and given in-depth examination for final results. Below are samples: In certain cases, a contrast dye may be given to the patient (Parker 2012). This may be administered through the veins or taken orally through the mouth. This dye makes the images of organs visible hence making it easy to identify and study on the computer screen. CT scan has a great advantage in that it can be used in any part of the body (Frantz 2013). It also provides clear images that can be easily interpreted and the problem source can be easily diagnosed. Some of the similarities that exist between CT scan and the DTPA scan are that both of them can be used in making in-depth analysis of the kidneys (Liu 2012). They both scan the intended areas for the targeted results; however, DTPA scan has always been considered more detailed and specific as compared to these other imaging modalities (Karthikeyan and Deepa 2009). While CT scan can be used to scan any part of the body, DTPA is only intended for the kidney and its functionality. It thus tends to bring more specific results as compared to these others. Some of the risks patients may face during CT scan come as a result of getting exposed to the ionizing radiation as well as intravenous scan agent. The ionizing radiation increases a person’s chance of contacting cancer in his/her lifetime. This ionizing radiation is particularly a great risk to pediatrics since the risk of cancer per unit dose of the ionizing radiation is high for young patients as compared to older ones. It is thus paramount that the exposure settings for minors be checked well appropriately since the use of excessive radiation dose may increase their chances of getting cancer. Consequently, the patient may suffer from nausea and hives caused by the contrast, which is normally injected before the scan (Zilberman, Tsivian & Lipkin 2011). Cautionary measures should thus be taken to eliminate any possible risk of such exposure. Conclusion DTPA scan plays a major role in examination of the kidneys and its components like the ureters, bladder and blood circulation. The DTPA scan is also done to monitor blood supply and functioning of the kidneys. Also, it is done to monitor the functioning of the renal tubular. Most professionals also like engaging it when checking for renovascular hypertension. Other functions include diagnosing renal artery stenosis, renal tubular obstruction and assessment of a patient’s recovery performance after a kidney transplant. Despite the existence of other imaging modalities, DTPA has always proved effective in provision of quality results. Also, the radioactive materialized during the scan are not dangerous hence do not result in dire side effects. These processes are often conducted by professional nuclear medicine specialists. More modalities can be used in the scanning process; like the intravenous urography, renal ultrasound and CT scan urography. All these function in the same manner as the DTPA scan, except that some little difference may exist in the depth of the scan and the procedure used in finding the conclusive results. References: Bates, Jane A.. Abdominal ultrasound: how, why, and when. 3rd ed. Edinburgh: Churchill Livingstone Elsevier, 2011. Forster, Michelle, and Marianne Duffy. Having a CT scan: this leaflet explains what happens when you go to hospital for a CT scan. London: Elfrida Society, 2012. Frantz, Margery. Urologic Surgeries and Procedures. New Delhi: World Technologies, 2012. Fulgham, Pat F.. Practical urological ultrasound. New York: Humana Press, 2013. Goldberg, Barry B., and John P. McGahan. Atlas of ultrasound measurements. 2nd ed. Philadelphia, PA: Mosby, 2010. Karthikeyan, Daniels and Deepa, Chegu. CT scan. Tunbridge Wells: Anshan, 2009. Kempi, Viktor. Preparation and application of 99mTc-DTPA to renal and vesicoureteral studies: a stochastic approach with deconvolution analysis. New York: NY publications, 2010. Liu, Jing. Tomography in intravenous angiography and fan-beam helical scan CT. New York, N.Y.: NY publications, 2012. Meyers, Trula. Nuclear medicine (specialty of medicine). Delhi: Research World, 2012. Monrow, Jensen . Impact of geometric mean imaging in the accurate determination of partial function in MAG3 renal scanning in a patient with retroperitoneal mass. 2011: EduRad Publishing, 20110618. Moreau, Jason and Laure, Mazzara. Intravenous urography. New York: Wiley, 2012. NY publications, 2011. Differential renal function measured by 99Tcm DTPA and 99 Tcm DMSA in a complete unilateral renal obstruction rat model. New York: NY publications, 2011. Parker, James N.. CT scan a medical dictionary, bibliography, and annotated research guide to Internet references. San Diego, CA: ICON Health, 2012. Silverstein, Douglas M., and Jordan Symons. Pediatric Nephrology a Handbook for Training Health Care Providers.. Singapore: World Scientific, 2012. Steinbock, Aleksanteri. Intravenous urography and retrograde pyelography in subcutaneous injuries of kidney; with a supplement, Rupture of the ureter, report of a case.. NY: NY publications, 2010. Tempkin, Betty Bates. Ultrasound scanning: principles and protocols. 3rd ed. St. Louis, Mo.: Saunders/Elsevier, 2009. Thomas, Adrian, Arpan K. Banerjee, and Uwe Busch. Classic papers in modern diagnostic radiology. Berlin: Springer, 2009. V, Cathreen. Role of intravenous urography and transabdominal ultrasonography in the diagnosis of bladder carcinoma. NY: NY publications, 2011. Wesson, Miley Barton. Intravenous urography: a new diagnostic procedure for for the general practitioner. S.l.: s.n., 2008. York, N.Y.. Intravenous (excretion) urography and retrograde pyelography. New York, N.Y.: Winthrop Chemical Co., 2009. Ferrandino M.N., Bagrodia A, Pierre SA. Radiation exposure in the acute and short-term management of urolithiasis at 2 academic centers. J Urol 181:668–672, discussion 673. 2009. Lamb A. D. et al. Plain radiography still is required in the planning of treatment for urolithiasis. J Endourol 22:2201–2205.2008. Mancini J. G. &Ferrandino M. N. The impact of new methods of imaging on radiation dosage delivered to patients.Curr Opin Urol. 20(2):163-8.2010. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/19940771 Mark J. Shumate MJ, Kooby DA, Alazraki NP: A Clinician's Guide to Nuclear Oncology: Practical Molecular Imaging and Radionuclide Therapies. Society of Nuclear Medicine, January 2007 Mas JC: A Patient's Guide to Nuclear Medicine Procedures: English-Spanish. Society of Nuclear Medicine, 2008 Meredith E. & Reed W. Ureteral calculi imaging: a literature review comparing plain film studies, contrast media studies, ultrasound and computed tomography. Australia Institute of Radiography 56 (3): 19-24. 2009.http://www.minnisjournals.com.au/_images/articles/pdf/article-pdf-0162.pdf Mettler F.A.Jr, Huda W, Yoshizumi T.T. et al. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology 248:254–263.2008. Rao, P. N. Imaging for kidney stones. World J Urol 22: 323–327. 2007. Retrieved from: http://emed.chris-barton.com/PDF/kidney%20stones%20pathophys%20and%20rx.pdf Viprakasit D.P., Sawyer M.D. &Herrell SD et al. Limitations of ultrasonography in the evaluation of urolithiasis: a correlation with computed tomography. J Endourol. Mar; 26 (3):209–13. 2012. Zilberman D.E, Tsivian M &Lipkin M.E. et al. Low dose computerized tomography for detection of urolithiasis – its effectiveness in the setting of the urology clinic. J Urol 185:910–914. 2011. Murari, SB., Gadepalli, T., Rao, VP and Ram, R. 2012. “Renal scintigraphy in diagnosis and management of nephroptosis.” Indian Journal of Nuclear Medicine27: 52-54. Ghfir, I., Boumaaza, O. and Rais, N. B. 2008. “Contribution of 99mTc-DTPA scintigraphy with diuretic test in the exploration of acute urinary obstruction in a transplant patient”. The Internet Journal of Nuclear Medicine 5(1). Gupta, S.K., Lewis, G., Rogers, K. and Attia, J. 2012. “Quantitative Tc-99m DTPA renal transplant scintigraphy predicts graft survival in the very early postoperative period.” Nuclear Medicine Communications Nucmed.com. 2009. “FAQ.” Accessed August 3, http://www.nucmed.com.au/faqs.php Tuna, H., Cermik, T.F. and Tuna, F. 2012. “Monitoring of renal function using (99m)Tc-DMSA and (99m)Tc-DTPA scintigraphy in patients with spinal cord injury.” Revista Espanola De Medicina Nuclear e Imagen Molecular. 31(6):322-327. Abdulsamea, S., Anderson, P., Biassoni, L and Brennan, E. 2010. “Pre- and postcaptopril renal scintigraphy as a screening test for renovascular hyptertension in children.” Pediatr Nephrol 25:317-322. Tullus K, Brennan E, Hamilton G, Lord R, McLaren C, Marks S, Roebuck DJ. 2008. “Renovascular hypertension in children.” Lancet 371:1453–1463. Jeon, H. G., Lee, S. R., Joo, D. J. and Oh, Y. T. 2010. “Predictors of Kidney Volume Change and Delayed Kidney Function Recovery After Donor Nephrectomy.” The Journal of Urology 184(3):1057-1063. Herts BR, Sharma N, Lieber M. 2009. “Estimating glomerular filtration rate in kidney donors: a model constructed with renal volume measurements from donor CT scans.” Radiology 252:109 Jeldres C, Bensalah K and Capitanio U. 2009. “Baseline renal function, ischaemia time and blood loss predict the rate of renal failure after partial nephrectomy.” BJU Int. 103:1632 Meltem, C., Kara, G. G. and Erdem, K. 2008. “Differential renal function estimation by dynamic renal scintigraphy: influence of background definition and pharmaceutical.” Nuclear Medicine Communications 29(11):1002-1005. Brant, W. E. and Helms, C. A. 2012. 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