Girolamo Tartaglione MD, Presenter: Nothing to Disclose

Matteo Vittori MD, Abstract Co-Author: Nothing to Disclose

Alessandro Cina MD, Abstract Co-Author: Nothing to Disclose

ALESSANDRO D'ADDESSI MD, Abstract Co-Author: Nothing to Disclose

PIERFRANCESCO BASSI PhD, Abstract Co-Author: Nothing to Disclose

Purpose: PerCutaneous Nephrostomy (PCN) is an emergency procedure to relieve an obstructed or infected collecting renal system. Indwelling catheters are placed to a gravity drainage bag. Before planning surgery is recommended to evaluate renal function and drainage. After consultation with urologist, we performed diuresis renography with PCN clamped in seated position, using a new procedure F+10(sp) 

Material and Methods: 36 Patients (20 m, 16 f). 4 pts had a bilateral PCN. The test was deferred for several days after positioning PCN, to enable the urinary system to decompress. Renograms were performed in posterior view, using a dual detector system with rectangular large view (Infinia II-Xeleris, GE), with a single-head flexibility allowing scan in seated position. The FOV included the kidneys, heart, and bladder. Before study the PCN was clamped. A dose of 99mTc-MAG3, 150 MBq was injected IV. A 20-min dynamic phase was acquired, with a frame rate of 2 s/frame for the first 60 frames, and 10 s/frame for 108 frames, using a 128x128 matrix and zoom 1. At 5 min after tracer injection, the pts drank 400-500 mL of water. A dose of 20 mg of Furosemide was injected IV at 10 min during dynamic acquisition (F+10sp). The clamp was removed at end of study, or during the test in presence of obstruction signs or symptoms.

Results 20 kidneys had a complete obstruction, whereas 7 had a partial obstruction (ratio 20min/peak >0.25). 7 kidneys had a normal drainage (Tmax< 6mins; ratio 20min/peak <0.25). 6 kidneys showed a poorly function (split renal function <10%). 

Conclusion Diuresis renography in seated position may allow a better discrimination between obstruction and normal kidney, thanks to the gravity effect. The drainage index ratio 20min/peak may reduce equivocal or false-positive results. In pts with signs or symptoms of obstruction during the test, the urine drainage by PCN may be quickly restored removing clamp, without moving the patient or disrupting the renogram. F+10(sp) is well tolerated also in pts with Creatinine level >2 mg/dL. This test may be an useful alternative to antegrade or retrograde pyelogram in patients at risk of infection or contrast allergy.

Diuresis Renography in seated position, F+10(sp), may be an useful alternative to antegrade/retrograde pyelogram in PerCutaneous Nephrostomy at risk of infection, contrast allergy or Creatinine level >2mg/dL.

Tartaglione, G, Vittori, M, Cina, A, D'ADDESSI, A, BASSI, P, PerCutaneous Nephrostomy: Diuresis Renography in Seated Position (F+10sp) and its Role in Post-Emergency Management.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045468.html