A Clinical Study of the Organ Distribution and Renoscintigram with Hg203 Labeled Neohydrin in Renal Diseases

Kim, Joon Tong; Lee, Hak Song; Lee, Munho

Abstract

The delineation of the functioning renal parenchyma by the scintiscanning technique has made it possible to supplement diagnostic informations obtained by ordinary urological laboratory data, intravenous pyelography, retrograde pyelography or aortic angiography. More recently, the Hean labeled neohydrin has turned out to be preferable to I131 labeled diodrast or hippuran for renoscintigram for that the former is more readily taken up by the renal cortex and retained by the renal tubules for certain period of time, while the latter istoo rapidly excreted in the urine to reveal satisfactory pictures of renoscan and the technique is complicated. In the present study, renal scintillation scanning and body surface counting in vivo by Hg203 neohydrin were performed on 10 normal cases and 50 patients, 2 renal tumor (Wilm's tumor), 12 renal tuberculosis, 6 renal calculi, 5 nephritis, 10 hydronephrosis. 1 nephrotic syndrome. 5 pyelonephritis, 1 polycystic kidney, 3 congenital anomalies (horse-shoe kidney) and 5 hypertension. After intravenous administration of about 100 microcuries of Hg203 labeled neohydrin, in vivo surface counting over the kidneys, liver, spleen, heart and thigh was performed prior to scan such kidneys at 5, 30, 60 and 90 minutes, respectively, by scintillation detector with 1.5 inches thick Na I crystal. Upon adequate concentration of Hg203 neohydrin in the kidneys, the outline of functioning renal parenchyma can then be recorded by scintillation scanning apparatus, 19 honey cone collimator. In body surface counting, the radioisotope concentration over normally functioning renal parenchyma is good, whereas the concentration over diseased parenchyma is poor and the hepatic uptakeof the isotope shows high, instead. This procedure would also be of diagnostic value in patients with renal vascular disease, by revealing renal function test. In renoscintigram of the patients having presumable renal diseases by ordinary urological survey and pyelographic techniques, space occupying lesions and dot irregularities of the kidney can be presented as filling defect on renoscan. Split renal function studies usually give some information about total functioning capacity of each kidney but no detailed information in limited areasof a kidney with segmental lesion can be drawn. The renal angiogram details in a precise way the size and course of the renal arteries, but contributes no information about function of the parenchyma. The renal biopsy is also a valuable diagnostic procedure which may provide a specific diagnosis if the biopsy is obtained from the right site of diseased area. And the radioisotope renogram has been used to detect unilateral renal disease and it provides some information about the vascular supply and functional capacity of each kidney but this procedure does not supply any knowledge on segmental renal lesion nor segmental renal function. The technique of renoscintigram using Hg203 neohydrin which supplements the disadvantages of conventional methods of renal function study is at the present most qualified to supply more knowledge on segmental renal function and morphological finding as well. Further-more, disappearance of the isotope from the blood and its urinary excretion rate were determined as no harm at all to the human body. In summary, the renoscintigram is of particular help in establishing the diagnosis of renal diseases where pyelographic evidence is equivocal or lacking and the diagnostic significance of this method is promising.