Evolving role of nuclear medicine modalities in the evaluation of renal diseases

Abstract

Background: Nuclear medicine in renal diseases is becoming one of the most important modalities of investigation. Material and methods: The study involved a search of the Pubmed Central database with the keywords renal scintigraphy, renal diseases, nuclear medicine, kidney function. The retrieved articles were studied and nuclear medicine techniques used for evaluation of kidney diseases were summarized. Results: The search revealed 9899 articles, which were subsequently filtered according to their relevance. The results show several groups of radiopharmaceuticals used for evaluation of renal function and renal abnormalities. Tubular secretion agents such as Tc-99m MAG3 are most commonly used for evaluating renal function, obtaining renograms and a variety of parameters reflecting differential renal function such as time to peak activity, relative renal uptake ratios at 2 to 3 minutes, half time excretion, differential cortical excretion at 15 minutes, 20-min to peak count ratio, etc. Glomerular filtration agents such as Tc-99m DTPA and 125-I-labeled sodium lothalamate (Glofil) are commonly used for evaluation of glomerular filtration rate. Renal cortical agents such as Tc-99m DMSA and Tc-99m glucoheptonate are used for visualization of renal parenchyma due to their ability to bind for a sufficiently long period to the renal tubules, allowing their visualization. Positron emission tomography agents such as 2-deoxy-2-[fluorine-18]fluoro- D-glucose (18F-FDG) are commonly used for evaluation of patients with primary renal malignancies or metastatic renal lesions. A variety of other radiopharmaceuticals are also under development or used for research purposes. Conclusions: Nuclear medicine is increasingly being used in patients with various renal abnormalities and its area of applications is expanding.