Diagnosis of kidney transplant obstruction using Mag3 diuretic renography
Kidney transplant obstruction (KTO) following renal transplantation remains an important reversible cause of allograft dysfunction, requiring prompt diagnosis to prevent long‐term graft damage. Although ultrasound can accurately diagnose renal transplant hydronephrosis, it cannot be used to assess i...
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| Veröffentlicht in: | Clinical transplantation 2001-02, Vol.15 (1), p.11-18 |
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| creator | Nankivell, Brian J Cohn, Deborah A Spicer, S Timothy Evans, Scott G Chapman, Jeremy R Gruenewald, Simon M |
| description | Kidney transplant obstruction (KTO) following renal transplantation remains an important reversible cause of allograft dysfunction, requiring prompt diagnosis to prevent long‐term graft damage. Although ultrasound can accurately diagnose renal transplant hydronephrosis, it cannot be used to assess its functional significance. We prospectively assessed the utility of technetium‐99m mercaptoacetyltriglycine (Tc99m MAG3) diuretic renography for the diagnosis of allograft KTO, using standard visual and quantitative parameters, as well as calculated renal output efficiency (OE), which has been postulated to improve diagnostic yield. From a cohort of 45 renal transplant patients, two subgroups were formed. The first group of transplant recipients (n=21) with stable function and no obstruction was used to derive normal values for Tc99m MAG3 scans. A second group of transplant recipients with acute renal dysfunction in whom KTO was clinically suspected was used to test the diagnostic utility of these derived values (n=43 scans). KTO was diagnosed independently of the MAG3 scans by a fall in the serum creatinine in response to renal pelvis urinary drainage. OE in 12 renal allografts with KTO was significantly reduced compared with 31 Tc99m MAG3 scans without KTO (59.6±18.9 vs. 81.6±5.4%, p |
| doi_str_mv | 10.1034/j.1399-0012.2001.150103.x |
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Although ultrasound can accurately diagnose renal transplant hydronephrosis, it cannot be used to assess its functional significance. We prospectively assessed the utility of technetium‐99m mercaptoacetyltriglycine (Tc99m MAG3) diuretic renography for the diagnosis of allograft KTO, using standard visual and quantitative parameters, as well as calculated renal output efficiency (OE), which has been postulated to improve diagnostic yield. From a cohort of 45 renal transplant patients, two subgroups were formed. The first group of transplant recipients (n=21) with stable function and no obstruction was used to derive normal values for Tc99m MAG3 scans. A second group of transplant recipients with acute renal dysfunction in whom KTO was clinically suspected was used to test the diagnostic utility of these derived values (n=43 scans). KTO was diagnosed independently of the MAG3 scans by a fall in the serum creatinine in response to renal pelvis urinary drainage. OE in 12 renal allografts with KTO was significantly reduced compared with 31 Tc99m MAG3 scans without KTO (59.6±18.9 vs. 81.6±5.4%, p<0.001). In KTO, the mean time of isotope appearance in the bladder (time to bladder [TTB]) was extended compared with unobstructed allografts (7.9±4.1 vs. 3.6±1.5 min, p<0.001). Measurement of OE significantly improved the accuracy of diuretic MAG3 renography in the diagnosis of renal allograft KTO, especially when supplemented by the TTB, parenchymal transit time and shape of the renogram curve. Ureteric obstruction of the kidney transplant can be diagnosed with an OE reduced to <75% (sensitivity 92%, specificity 87%) and confirmed by isotope hold‐up in the pelvicalyceal system. A normal or slowly declining renogram curve effectively excluded KTO (sensitivity of 96%, negative predictive value of 84%). A parenchymal transit time of >5 min and a TTB of >7 min both yielded a sensitvity of 92% and a specificity of 81%. In conclusion, MAG3 renography is a clinically useful investigation for the diagnosis of KTO.</description><identifier>ISSN: 0902-0063</identifier><identifier>EISSN: 1399-0012</identifier><identifier>DOI: 10.1034/j.1399-0012.2001.150103.x</identifier><identifier>PMID: 11168310</identifier><language>eng</language><publisher>Copenhagen: Munksgaard International Publishers</publisher><subject>Adult ; Biological and medical sciences ; diuretic renography ; Diuretics ; Female ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Kidney Transplantation ; Linear Models ; MAG3 ; Male ; Medical sciences ; output efficiency ; Postoperative Complications - diagnostic imaging ; Radioisotope Renography ; Radionuclide investigations ; Radiopharmaceuticals ; Retrospective Studies ; Technetium Tc 99m Mertiatide ; Ureteral Obstruction - diagnosis ; Ureteral Obstruction - diagnostic imaging ; urinary obstruction ; Urinary system</subject><ispartof>Clinical transplantation, 2001-02, Vol.15 (1), p.11-18</ispartof><rights>2001 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5313-8011f55129832a575973b5cdc5c91f5441510855651209257b486e48bc40f5963</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1034%2Fj.1399-0012.2001.150103.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1034%2Fj.1399-0012.2001.150103.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,777,781,1412,27905,27906,45555,45556</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=846220$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11168310$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nankivell, Brian J</creatorcontrib><creatorcontrib>Cohn, Deborah A</creatorcontrib><creatorcontrib>Spicer, S Timothy</creatorcontrib><creatorcontrib>Evans, Scott G</creatorcontrib><creatorcontrib>Chapman, Jeremy R</creatorcontrib><creatorcontrib>Gruenewald, Simon M</creatorcontrib><title>Diagnosis of kidney transplant obstruction using Mag3 diuretic renography</title><title>Clinical transplantation</title><addtitle>Clin Transplantation</addtitle><description>Kidney transplant obstruction (KTO) following renal transplantation remains an important reversible cause of allograft dysfunction, requiring prompt diagnosis to prevent long‐term graft damage. Although ultrasound can accurately diagnose renal transplant hydronephrosis, it cannot be used to assess its functional significance. We prospectively assessed the utility of technetium‐99m mercaptoacetyltriglycine (Tc99m MAG3) diuretic renography for the diagnosis of allograft KTO, using standard visual and quantitative parameters, as well as calculated renal output efficiency (OE), which has been postulated to improve diagnostic yield. From a cohort of 45 renal transplant patients, two subgroups were formed. The first group of transplant recipients (n=21) with stable function and no obstruction was used to derive normal values for Tc99m MAG3 scans. A second group of transplant recipients with acute renal dysfunction in whom KTO was clinically suspected was used to test the diagnostic utility of these derived values (n=43 scans). KTO was diagnosed independently of the MAG3 scans by a fall in the serum creatinine in response to renal pelvis urinary drainage. OE in 12 renal allografts with KTO was significantly reduced compared with 31 Tc99m MAG3 scans without KTO (59.6±18.9 vs. 81.6±5.4%, p<0.001). In KTO, the mean time of isotope appearance in the bladder (time to bladder [TTB]) was extended compared with unobstructed allografts (7.9±4.1 vs. 3.6±1.5 min, p<0.001). Measurement of OE significantly improved the accuracy of diuretic MAG3 renography in the diagnosis of renal allograft KTO, especially when supplemented by the TTB, parenchymal transit time and shape of the renogram curve. Ureteric obstruction of the kidney transplant can be diagnosed with an OE reduced to <75% (sensitivity 92%, specificity 87%) and confirmed by isotope hold‐up in the pelvicalyceal system. A normal or slowly declining renogram curve effectively excluded KTO (sensitivity of 96%, negative predictive value of 84%). A parenchymal transit time of >5 min and a TTB of >7 min both yielded a sensitvity of 92% and a specificity of 81%. In conclusion, MAG3 renography is a clinically useful investigation for the diagnosis of KTO.</description><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>diuretic renography</subject><subject>Diuretics</subject><subject>Female</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Kidney Transplantation</subject><subject>Linear Models</subject><subject>MAG3</subject><subject>Male</subject><subject>Medical sciences</subject><subject>output efficiency</subject><subject>Postoperative Complications - diagnostic imaging</subject><subject>Radioisotope Renography</subject><subject>Radionuclide investigations</subject><subject>Radiopharmaceuticals</subject><subject>Retrospective Studies</subject><subject>Technetium Tc 99m Mertiatide</subject><subject>Ureteral Obstruction - diagnosis</subject><subject>Ureteral Obstruction - diagnostic imaging</subject><subject>urinary obstruction</subject><subject>Urinary system</subject><issn>0902-0063</issn><issn>1399-0012</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkF1P2zAUhi00NArbX5gyTeIuwSf-SHy3rXxKhSFUxO4sx3U6t2nS2Ylo_j2OUpVbbuwjn-e8x3oQ-g44AUzoxSoBIkSMMaRJGs4EGA6NZHeEJofOJzTBAqeh5uQEnXq_Cq8cOPuMTgCA5wTwBN1dWrWsG2991JTR2i5q00etU7XfVqpuo6bwret0a5s66rytl9G9WpJoYTtnWqsjZ-pm6dT2X_8FHZeq8ubr_j5Dz9dX8-ltPPtzczf9NYs1I0DiHAOUjEEqcpIqljGRkYLphWZahAalwADnjPGAYJGyrKA5NzQvNMUlE5ycofMxd-ua_53xrdxYr00VvmuazssMh8iM0ACKEdSu8d6ZUm6d3SjXS8By8ChXcrAlB1ty8ChHj3IXZr_tl3TFxizeJ_fiAvBjDyivVVUGY9r6A5dTnqYD9XOkXm1l-o_vl9P501iHiHiMsL41u0OEcmvJM5Ix-fJwI8XTb0r-zpl8JG8lFpsu</recordid><startdate>200102</startdate><enddate>200102</enddate><creator>Nankivell, Brian J</creator><creator>Cohn, Deborah A</creator><creator>Spicer, S Timothy</creator><creator>Evans, Scott G</creator><creator>Chapman, Jeremy R</creator><creator>Gruenewald, Simon M</creator><general>Munksgaard International Publishers</general><general>Blackwell</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200102</creationdate><title>Diagnosis of kidney transplant obstruction using Mag3 diuretic renography</title><author>Nankivell, Brian J ; Cohn, Deborah A ; Spicer, S Timothy ; Evans, Scott G ; Chapman, Jeremy R ; Gruenewald, Simon M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5313-8011f55129832a575973b5cdc5c91f5441510855651209257b486e48bc40f5963</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>diuretic renography</topic><topic>Diuretics</topic><topic>Female</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Kidney Transplantation</topic><topic>Linear Models</topic><topic>MAG3</topic><topic>Male</topic><topic>Medical sciences</topic><topic>output efficiency</topic><topic>Postoperative Complications - diagnostic imaging</topic><topic>Radioisotope Renography</topic><topic>Radionuclide investigations</topic><topic>Radiopharmaceuticals</topic><topic>Retrospective Studies</topic><topic>Technetium Tc 99m Mertiatide</topic><topic>Ureteral Obstruction - diagnosis</topic><topic>Ureteral Obstruction - diagnostic imaging</topic><topic>urinary obstruction</topic><topic>Urinary system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nankivell, Brian J</creatorcontrib><creatorcontrib>Cohn, Deborah A</creatorcontrib><creatorcontrib>Spicer, S Timothy</creatorcontrib><creatorcontrib>Evans, Scott G</creatorcontrib><creatorcontrib>Chapman, Jeremy R</creatorcontrib><creatorcontrib>Gruenewald, Simon M</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nankivell, Brian J</au><au>Cohn, Deborah A</au><au>Spicer, S Timothy</au><au>Evans, Scott G</au><au>Chapman, Jeremy R</au><au>Gruenewald, Simon M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diagnosis of kidney transplant obstruction using Mag3 diuretic renography</atitle><jtitle>Clinical transplantation</jtitle><addtitle>Clin Transplantation</addtitle><date>2001-02</date><risdate>2001</risdate><volume>15</volume><issue>1</issue><spage>11</spage><epage>18</epage><pages>11-18</pages><issn>0902-0063</issn><eissn>1399-0012</eissn><abstract>Kidney transplant obstruction (KTO) following renal transplantation remains an important reversible cause of allograft dysfunction, requiring prompt diagnosis to prevent long‐term graft damage. Although ultrasound can accurately diagnose renal transplant hydronephrosis, it cannot be used to assess its functional significance. We prospectively assessed the utility of technetium‐99m mercaptoacetyltriglycine (Tc99m MAG3) diuretic renography for the diagnosis of allograft KTO, using standard visual and quantitative parameters, as well as calculated renal output efficiency (OE), which has been postulated to improve diagnostic yield. From a cohort of 45 renal transplant patients, two subgroups were formed. The first group of transplant recipients (n=21) with stable function and no obstruction was used to derive normal values for Tc99m MAG3 scans. A second group of transplant recipients with acute renal dysfunction in whom KTO was clinically suspected was used to test the diagnostic utility of these derived values (n=43 scans). KTO was diagnosed independently of the MAG3 scans by a fall in the serum creatinine in response to renal pelvis urinary drainage. OE in 12 renal allografts with KTO was significantly reduced compared with 31 Tc99m MAG3 scans without KTO (59.6±18.9 vs. 81.6±5.4%, p<0.001). In KTO, the mean time of isotope appearance in the bladder (time to bladder [TTB]) was extended compared with unobstructed allografts (7.9±4.1 vs. 3.6±1.5 min, p<0.001). Measurement of OE significantly improved the accuracy of diuretic MAG3 renography in the diagnosis of renal allograft KTO, especially when supplemented by the TTB, parenchymal transit time and shape of the renogram curve. Ureteric obstruction of the kidney transplant can be diagnosed with an OE reduced to <75% (sensitivity 92%, specificity 87%) and confirmed by isotope hold‐up in the pelvicalyceal system. A normal or slowly declining renogram curve effectively excluded KTO (sensitivity of 96%, negative predictive value of 84%). A parenchymal transit time of >5 min and a TTB of >7 min both yielded a sensitvity of 92% and a specificity of 81%. In conclusion, MAG3 renography is a clinically useful investigation for the diagnosis of KTO.</abstract><cop>Copenhagen</cop><pub>Munksgaard International Publishers</pub><pmid>11168310</pmid><doi>10.1034/j.1399-0012.2001.150103.x</doi><tpages>8</tpages></addata></record> |
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| subjects | Adult Biological and medical sciences diuretic renography Diuretics Female Humans Investigative techniques, diagnostic techniques (general aspects) Kidney Transplantation Linear Models MAG3 Male Medical sciences output efficiency Postoperative Complications - diagnostic imaging Radioisotope Renography Radionuclide investigations Radiopharmaceuticals Retrospective Studies Technetium Tc 99m Mertiatide Ureteral Obstruction - diagnosis Ureteral Obstruction - diagnostic imaging urinary obstruction Urinary system |
| title | Diagnosis of kidney transplant obstruction using Mag3 diuretic renography |
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