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Nuclear Med Class 2024 > Renal Study Guide > Flashcards

Renal Study Guide Flashcards

1
Q

What is the anatomical span of the kidneys?

A

The kidneys span the distance between the 12th thoracic vertebra and 3rd lumbar vertebrae

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2
Q

The kidneys lie more _______.

A

Posterior

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3
Q

Which kidney is more frequently ectopic?

A

The right kidney is slightly lower than the left kidney, it is more prone to being ectopic

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4
Q

What connects the renal pelvis to the bladder?

A

The renal pelvis drains into the ureters into bladder

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5
Q

What is the functional unit of the kidney?

A

The functional unit of the kidneys is the nephrons

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6
Q

What are the three main functions of the nephrons?

A

The three main functions of the nephrons are:
* filtration
* secretion
* reabsorption

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7
Q

Where are the nephrons located within the kidney?

A

Nephrons are located within the renal cortex

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8
Q

True or False: Nephrons can regenerate.

A

False

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9
Q

The number of nephrons you have are _______.

A

constant from birth

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10
Q

How are GFR and BP related?

A

GFR and BP are directly related

If blood pressure increases, the GFR also increases.

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11
Q

What is a normal GFR?

A

125 ml/min

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12
Q

The kidneys produce and secrete _______ which helps regulate BP.

A

renin

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13
Q

What are two common agents used for functional renal imaging?

A

99mTc-MAG3 or 99mTc-DTPA

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14
Q

What are the most common agents used for morphologic renal imaging?

A

99mTc-GH or 99mTc-DSMA

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15
Q

What happens if the GFR is too high?

A

Some needed substances may pass through too quickly and are not absorbed into the body.

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16
Q

What does ACE stand for?

A

Angiotensin Converting Enzymes

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17
Q

List the four functions of Angiotensin II.

A
  • Vasoconstriction: constricts arterioles of the kidneys to raise GFR
  • Aldosterone: stimulates the adrenal cortex to secrete aldosterone which enhances reabsorption
  • Thirst: acts on the thirst center to increase water intake
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18
Q

What is the best view for demonstrating a horseshoe kidney?

A

Anterior view

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19
Q

A neobladder made from a portion of the small bowel is called _______.

A

Dead loop

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20
Q

Angiotensin II through all its functions, has a (raises/lowers) BP.

A

Raises blood pressure

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21
Q

Kidney stones consist of _______.

A

Crystallized salts, calcium oxalate, calcium phosphate

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22
Q

What is the ‘commercial’ name for MAG3?

A

Mertiatide

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23
Q

What does ERPF stand for?

A

Effective Renal Plasma Flow

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24
Q

If normal ERPF is about 600ml/min, what is the normal GFR?

A

120 ml/min

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25
Q

What is the ratio of GFR to ERPF?

A

20%

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26
Q

What is ERPF a measure of?

A

How effectively the kidneys remove a substance from the blood

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27
Q

Which statement is true: MAG3 is cleared from the body by glomerular filtration or by tubular secretion?

A

Both statements are true; MAG3 is mainly cleared by tubular secretion (80%)

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28
Q

How is DTPA removed from the kidneys?

A

DTPA is cleared from the kidneys by glomerular filtration. It is rapidly taken up and cleared by a normal kidney.

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29
Q

What are the dose ranges for DMSA and GH?

A

1-5 mCi for DMSA and 10-20 mCi for GH.

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30
Q

Absolute renal function typically refers to the _______.

A

GFR

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31
Q

List a few advantages of GH over DMSA.

A
  • GH is a little more stable than DMSA
  • Larger doses of GH permit better perfusion imaging
  • GH allows quicker cortex imaging
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32
Q

What role would dehydration play in a patient undergoing a functional renal study?

A

Dehydration causes a delay in uptake in the kidneys and a delay in excretion of the kidneys.

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33
Q

How does Lasix administration during a renal scan help rule out or confirm an obstruction?

A

Lasix is a diuretic given to determine obstruction because a normal kidney will quickly excrete activity while an abnormal kidney (obstruction) will gradually increase in activity with no excretion.

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34
Q

What is an adult dose of Lasix and a pediatric dose?

A

An adult dose of Lasix is 40 mg and 1 mg/kg for a pediatric dose.

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35
Q

What is indicated by a clearance half-time of less than 10 minutes after furosemide injection in a diuretic renal imaging study?

A

dilated but unobstructed kidney

This suggests that the kidney is functioning but has dilation without obstruction.

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36
Q

What does a renogram with peak activity in the kidney at 3 to 5 minutes and decreasing to less than 50% by 20 minutes indicate?

A

suspect this to be normal

A normal renogram indicates proper kidney function and tracer uptake.

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37
Q

When should Lasix be administered during a renal scan?

A

15 minutes post injection

Timing is critical for assessing renal function accurately.

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38
Q

When do the maximum effects of Lasix occur?

A

15 minutes past injection

This timing is essential for evaluating the diuretic’s impact on kidney function.

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39
Q

What are the three phases of the time activity curve in renal imaging?

A

vascular, secretory, excretory

These phases represent different processes of kidney function.

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40
Q

Name two ACE-inhibitor medications used for ACE-inhibitor renography.

A

Captopril, Enalaprilat (Vasotec)

These medications are used to evaluate renal function through imaging.

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41
Q

What can morphologic renal imaging document?

A

CFR and ERPE

CFR refers to the cortical filtration rate, and ERPE refers to the excretory renal pelvis evaluation.

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42
Q

What should a technologist do when a patient is scheduled for an indirect cystogram?

A

prepare the tracer dose for intravenous injection

Proper preparation is crucial for the success of the imaging procedure.

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43
Q

What is the biggest advantage of Vasotec over Captopril in imaging?

A

Imaging can start after 10 minutes with Vasotec, while with Captopril, you have to wait 60 minutes

This advantage facilitates quicker diagnostic procedures.

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44
Q

What effects do ACE inhibitors have in an ACE inhibitor Renography?

A

They stop the production of Angiotensin I being converted to Angiotensin II, preventing vasoconstriction, thirst, aldosterone, and ADH effects

This results in lower blood pressure and decreased GFR.

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45
Q

How will a kidney affected by RAS appear on a nuclear scan after the administration of Vasotec or Captopril?

A

There will be a delayed washout of activity due to decreased glomerular filtration from reduced blood flow

This will show a delay in uptake and washout in the images.

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46
Q

What is the normal split renal function for each kidney?

A

Each kidney should contribute at least 50% with a deviation of no more than plus/minus 10%

This indicates balanced renal function between the kidneys.

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47
Q

True or False: Renal Cell carcinoma generally shows increased concentration of DMSA and GH compared with normal surrounding renal parenchyma.

A

False

Renal cell carcinoma may have reduced uptake due to loss of normal renal tissue function.

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48
Q

What should be visualized within 3 minutes on a normal renal scan?

A

The renal pelvis and collection system

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49
Q

What substance is traditionally used to determine the GFR by non-nuclear medicine techniques?

A

Creatinine/inulin

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50
Q

What is creatinine?

A

A waste product formed from the normal breakdown of muscle tissue

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51
Q

What is inulin?

A

A polysaccharide that is filtered at the glomerulus but not metabolized by the body

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52
Q

Why is inulin not commonly used in clinical practice?

A

Due to practical difficulties

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53
Q

What is the simplest way to reduce exposure to the bladder after a radionuclide renal study?

A

Voiding regularly

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54
Q

What is the major factor that determines if a substance is filtered by the kidneys?

A

Molecular size

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55
Q

What is the purpose of renal imaging?

A

To differentiate between a dilated renal collecting system and an obstructed renal collecting system

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56
Q

What diuretic is used in renal imaging to assess the collecting system?

A

Lasix

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57
Q

What is 99TCM - Gluconeptonate used for?

A

Renal perfusion imaging

It is indicated for assessing kidney function.

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58
Q

What is the typical dose range for 99TCM - Gluconeptonate?

A

10-20 mCi

This range is used for optimal imaging results.

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59
Q

What imaging does 99TCM - Gluconeptonate facilitate?

A

Cortex imaging

It allows for quicker imaging of the renal cortex.

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60
Q

How is 99TCM - Gluconeptonate cleared from the body?

A

By GFR and tubular secretion

This indicates its elimination processes in the kidneys.

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61
Q

What is the effect of a bigger dose of 99TCM - Gluconeptonate?

A

Quicker cortex imaging

Higher doses can enhance the speed of imaging results.

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62
Q

What is 99TEm - ОТРА used for?

A

GFR assessment

It is used to evaluate kidney function and blood flow.

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63
Q

What is the typical dose range for 99TEm - ОТРА?

A

10-20 mCi

This dosage is standard for effective imaging.

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64
Q

What does GFR stand for?

A

Glomerular filtration rate

It is a key indicator of kidney function.

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65
Q

What does aqTEm - OMSA target in the kidneys?

A

Renal parenchyma

It assesses the functional aspects of the kidneys.

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66
Q

What is the typical dose range for aqTEm - OMSA?

A

1-5 mCi

This lower dose is used for specific imaging needs.

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67
Q

What does cortical imaging with aqTEm - OMSA involve?

A

GFR and tubular secretion

It evaluates both the filtration and secretion capabilities of the kidneys.

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68
Q

What does aqTEm - OMSA bind to?

A

Tubules

This binding is crucial for assessing kidney function.

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69
Q

Where does DSMA remain during imaging?

A

In the cortex

This retention allows for better visualization of renal structures.

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70
Q

What does I-131 or I-123-OIH refer to?

A

Radioactive isotopes used in renal imaging

I-131 and I-123-OIH are used in diagnostic procedures to evaluate kidney function.

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71
Q

What are renal tubules?

A

The structures in the kidneys that reabsorb water and nutrients

Renal tubules play a critical role in urine formation and electrolyte balance.

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72
Q

What does GFR stand for?

A

Glomerular Filtration Rate

GFR is a test used to check how well the kidneys are filtering blood.

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73
Q

What is 99mTc-MAG3?

A

A radiopharmaceutical used for renal imaging

99mTc-MAG3 is commonly used to assess renal function and blood flow.

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74
Q

What does renal function refer to?

A

The ability of the kidneys to filter blood and produce urine

Renal function is crucial for maintaining homeostasis and electrolyte balance.

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75
Q

What is the typical dosage range for 99mTc-MAG3 in renal imaging?

A

5 - 10 mCi

This dosage is standard for effective renal imaging without excessive radiation exposure.

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76
Q

True or False: MAG3 is retained by normal kidneys.

A

False

MAG3 is not retained by normal kidneys and is excreted in urine.

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77
Q

What is the relationship between GFR and renal tubules?

A

GFR + Tubules indicates the combined assessment of filtration and reabsorption

Understanding both GFR and tubule function is essential for evaluating overall renal health.

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78
Q

What does the body produce as waste from metabolizing nutrients?

A

CO2, excess H2O, and heat

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79
Q

What are the toxic nitrogenous wastes produced from protein catabolism?

A

NH3 (ammonia) and urea

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80
Q

What are examples of essential ion wastes?

A
  • Na (sodium)
  • Cl- (chloride)
  • SO4 (sulfate)
  • HPO4 (phosphate)
  • H (hydrogen)
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81
Q

Which organ is primarily involved in eliminating water, nitrogenous wastes, some bacterial toxins, hydrogen, heat, and CO2?

A

Kidneys

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82
Q

What do the lungs primarily eliminate?

A

CO2, heat, and a little H2O

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83
Q

What substances does the skin eliminate?

A

Heat, H2O, CO2, salts, and urea

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84
Q

What does the GI tract eliminate?

A

Solid undigested wastes, CO2, H2O, salts, and heat

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85
Q

Fill in the blank: The body produces _______ from metabolizing nutrients.

A

CO2, excess H2O, and heat

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86
Q

True or False: The kidneys are involved in eliminating heat.

A

True

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87
Q

What are the waste products of protein catabolism?

A

NH3 (ammonia) and urea

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88
Q

What are the kidneys?

A

Paired reddish organs shaped like kidney beans

Kidneys are essential organs in the body that filter blood and produce urine.

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89
Q

Where are the kidneys located?

A

Just above the waist (posterior)

The kidneys are positioned in the retroperitoneal space.

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90
Q

How long and wide are the kidneys?

A

4-5 inches long, 2-3 inches wide, 1 inch thick

This size can vary slightly between individuals.

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91
Q

What is the hilus of the kidney?

A

Indentation where ureters, blood vessels, and lymphatic vessels enter and exit

The hilus is crucial for the kidney’s vascular and urinary connections.

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92
Q

What is the first part of the kidney?

A

Capsule

The capsule is the outer layer that surrounds and protects the kidney.

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93
Q

What does the renal capsule do?

A

Directly covers the kidney

It provides structural support and protection.

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94
Q

What is the second part of the kidney?

A

Cortex

The cortex is the outer reddish area of the kidney.

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95
Q

What is contained in the cortex?

A

Blood vessels and renal tubules

The cortex plays a key role in filtering blood and forming urine.

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96
Q

What is the third part of the kidney?

A

Medulla

The medulla is the inner region of the kidney.

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97
Q

What structures are found in the medulla?

A

8-18 cone-shaped renal pyramids

These pyramids are essential for urine collection and transportation.

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98
Q

What are renal pyramids?

A

Cone-shaped structures within the medulla

Renal pyramids contain blood vessels and tubules that extend from the cortex.

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99
Q

How do renal tubules relate to renal pyramids?

A

They start in the cortex and extend to the pyramids

This connection is vital for urine formation and flow.

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100
Q

What is the part of the kidneys that collects urine drained from the calyx?

A

Pelvis

The pelvis is located at the ends of the calyx.

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101
Q

What structure drains urine from the renal pelvis to the bladder?

A

Ureters

Ureters are located at the medial surface of the kidney.

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102
Q

What is the blood supply to the kidneys?

A

Renal arteries

The right and left renal arteries bring 1200 ml/min of blood to the kidneys.

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103
Q

What is the functional unit of the kidneys?

A

Nephron

Nephrons have three main functions: filtration, secretion, and reabsorption.

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104
Q

What are the three main functions of the nephron?

A
  • Filtration
  • Secretion
  • Reabsorption

Filtration removes substances from blood, secretion adds substances to the calyx, and reabsorption returns substances to the blood.

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105
Q

Where are nephrons located?

A

Renal cortex

Afferent arterioles bring blood to the nephrons, which are located in the renal cortex.

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106
Q

Fill in the blank: The kidneys have a good _______ supply because they filter the blood.

A

blood

This indicates the importance of the kidneys in blood filtration.

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107
Q

True or False: Blood exits the kidneys through renal arteries.

A

False

Blood exits through renal veins, not arteries.

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108
Q

What is the flow of blood in the kidneys starting from the renal arteries?

A
  • Renal arteries
  • Afferent arterioles
  • Nephrons
  • Renal veins

This flow highlights how blood is processed within the kidneys.

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109
Q

What is the role of afferent arterioles in the kidneys?

A

Bring blood to the nephrons

Afferent arterioles are crucial for supplying blood to the functional units of the kidneys.

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110
Q

What is the primary function of nephrons?

A

Nephrons filter substances out of the blood

This process starts in the renal cortex and continues in the tubules of the renal pyramids.

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111
Q

Where does reabsorption take place in the nephron?

A

Reabsorption takes place in both the cortex and pyramids

Some substances get reabsorbed back into the bloodstream.

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112
Q

What occurs at the end of the renal pyramids?

A

Secretion of urine occurs

Urine produced is secreted from the nephrons into the calyx.

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113
Q

Are the number of nephrons constant throughout a person’s life?

A

Yes, the number of nephrons is constant from birth

Nephrons will get larger, but new ones are not created. If damaged, other nephrons can take up the load.

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114
Q

What compensatory mechanism occurs if one kidney is removed?

A

The other kidney will compensate

Eventually, the two original kidneys will adapt to the loss.

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115
Q

What is the first step in producing urine?

A

Glomerular filtration

This involves forcing fluids and dissolved substances of the blood through glomerular capillaries.

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116
Q

What is the fluid called that results from glomerular filtration?

A

Filtrate

It enters the nephron with all the dissolved substances.

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117
Q

What is the source of pressure that drives glomerular filtration?

A

The pressure of blood

This pressure forces fluids and dissolved substances through the glomerular capillaries.

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118
Q

What is the normal Glomerular Filtration Rate (GFR)?

A

125 ml/min

Normal GFR indicates healthy kidney function.

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119
Q

How much urine enters the nephrons each day?

A

180 liters

This amount reflects the total filtrate produced by the kidneys.

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120
Q

What is the typical amount of urine excreted from the kidneys each day?

A

1-2 liters

This is the volume of urine that is actually eliminated from the body.

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121
Q

What happens to GFR if blood pressure drops?

A

GFR drops

A decrease in blood pressure can impair kidney function.

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122
Q

What may occur if GFR is too high?

A

Some needed substances may pass through quickly and not be absorbed

High GFR can lead to nutrient loss in urine.

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123
Q

What is the consequence of a low GFR?

A

Wastes may not be excreted

Low GFR can lead to accumulation of waste products in the body.

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124
Q

What is the role of renin in the Angiotensin I pathway?

A

Renin acts on Angiotensinogen to produce Angiotensin I

Renin is an enzyme produced by the kidneys that regulates blood pressure.

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125
Q

What do the liver produce related to the Angiotensin I pathway?

A

Angiotensinogen

Angiotensinogen is a plasma protein that is converted to Angiotensin I.

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126
Q

What converts Angiotensin I to Angiotensin II?

A

Angiotensin Converting Enzymes

This conversion is crucial for regulating blood pressure and fluid balance.

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127
Q

Fill in the blank: The filtrate that forms in all the _______ is crucial for kidney function.

A

nephrons

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128
Q

True or False: A normal GFR indicates that the kidneys are not functioning properly.

A

False

A normal GFR is a sign of healthy kidney function.

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129
Q

What is angiotensin II?

A

A peptide hormone that regulates blood pressure and fluid balance.

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130
Q

What is one of the primary functions of angiotensin II?

A

Vasoconstriction

Constricts arterioles of the kidneys to raise GFR.

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131
Q

How does angiotensin II affect aldosterone secretion?

A

Stimulates the adrenal cortex to secrete aldosterone.

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132
Q

What effect does aldosterone have on the kidneys?

A

Enhances absorption of Na.

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133
Q

What is the result of increased sodium absorption due to aldosterone?

A

Increases blood volume, blood pressure (BP), and GFR.

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134
Q

How does angiotensin II influence thirst?

A

Acts on the thirst center to increase water intake.

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135
Q

What is the role of antidiuretic hormone (ADH) in relation to angiotensin II?

A

Stimulates the release of ADH, causing kidneys to retain water.

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136
Q

What role do the kidneys play in blood pressure regulation?

A

They have the ability to raise and lower BP.

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137
Q

What is one of the functions of the kidneys regarding blood volume and composition?

A

Removes wastes, including hydrogen, to control blood pH.

138
Q

What hormone do the kidneys secrete to help regulate blood pressure?

A

Renin.

139
Q

Fill in the blank: Angiotensin II acts to _______ arterioles.

A

constrict

140
Q

What is Gluconeogenesis?

A

The formation of glucose from a non-carbohydrate source during fasting

Common non-carbohydrate sources include proteins.

141
Q

What hormone is secreted by the kidneys to stimulate the formation of red blood cells?

A

Erythropoietin

Erythropoietin is crucial for the production of red blood cells.

142
Q

What is the active form of Vitamin D synthesized in the body?

A

Calcitriol

Calcitriol helps maintain calcium levels for bones and normal chemical balance in the body.

143
Q

What is Uremia?

A

The build-up of urea in the blood

Uremia is higher in the advanced stages of kidney failure.

144
Q

What is Glomerulonephritis?

A

Inflammation of the glomeruli of the kidneys

It leads to a loss of filtering ability in the kidneys.

145
Q

What does Pyelitis refer to?

A

Inflammation of the renal pelvis

Pyelitis can lead to more severe kidney infections.

146
Q

What is Pyelonephritis?

A

Inflammation of the nephrons and renal pelvis

Pyelonephritis is a serious kidney infection.

147
Q

What condition is characterized by inflammation of the bladder?

A

Cystitis

Cystitis can eventually lead to urinary tract infections or kidney infections.

148
Q

What is a Urinary Tract Infection?

A

Infection in part of the urinary system or large amount of microbes in the urine

Symptoms can include bacteriuria, urethritis, cystitis, and pyelonephritis.

149
Q

What percentage of patients with hypertension is caused by Renovascular Hypertension (RUH)?

A

1-4%

RUH is primarily due to issues with the kidneys.

150
Q

What is the most common cause of Renovascular Hypertension?

A

Renal Artery Stenosis (RAS)

RAS is a blockage of the artery to the kidneys.

151
Q

What effect does Renal Artery Stenosis have on renin secretion?

A

It can cause an increase in renin secretion

Renin helps in the production of Angiotensin I.

152
Q

What is Angiotensin I converted to?

A

Angiotensin II

This conversion is facilitated by Angiotensin Converting Enzymes (ACE).

153
Q

What role do ACE inhibitors play in hypertension treatment?

A

They block the production of Angiotensin II

This helps to lower blood pressure.

154
Q

What characterizes Nephrotic Syndrome?

A

Protein in the urine

Edema can occur in the eyes, ankles, feet, and abdomen.

155
Q

What is renal failure?

A

Decrease or cessation of glomerular filtration

It can be acute or chronic.

156
Q

What is acute renal failure?

A

Stops working entirely

It is a sudden loss of kidney function.

157
Q

What is chronic renal failure?

A

Progressive and usually irreversible decline in GFR

It develops over time and leads to end-stage renal disease.

158
Q

Fill in the blank: Renovascular Hypertension is primarily caused by _______.

A

Renal Artery Stenosis

159
Q

True or False: Nephrotic Syndrome is characterized by the presence of blood in the urine.

A

False

Nephrotic Syndrome is characterized by protein in the urine, not blood.

160
Q

What is polycystic disease?

A

Cysts in the nephrons that deform the nephrons

Polycystic disease is a genetic disorder characterized by the growth of numerous cysts in the kidneys.

161
Q

What are ureters?

A

Tubes that drain urine from the kidneys to the bladder

Each kidney has one ureter, and they are approximately 10-12 inches long.

162
Q

Where do ureters enter the bladder?

A

Medially, on the posterior surface

This positioning is significant for the function of the ureters.

163
Q

What physiological feature prevents backflow of urine into the ureters?

A

The pressure from the filling bladder compresses the ureter openings

This mechanism acts as a physiologic valve.

164
Q

What is backflow of urine into the ureters also called?

A

Reflux

Reflux can lead to complications such as urinary tract infections (UTIs) and kidney infections.

165
Q

What is a possible problem that can occur in the ureters?

A

Kidney stones

Kidney stones are also known as renal calculi.

166
Q

What is urolithiasis?

A

Stones in the urinary tract

Urolithiasis can lead to pain and obstruction in the urinary system.

167
Q

What causes kidney stones to form?

A

Urine carries crystals of salt which may form into stones

These stones can get stuck in the ureters, causing severe pain.

168
Q

What is the bladder?

A

A hollow muscular organ

The bladder’s shape depends on the amount of urine it contains.

169
Q

What shape is the bladder when it is empty?

A

Collapsed

170
Q

What shape does the bladder take when it is ½ full?

A

Spherical

171
Q

What shape does the bladder take when it is more than ½ full?

A

Pear shaped

172
Q

Do females have smaller or larger bladders compared to males?

A

Smaller

173
Q

What is urination also known as?

A

Voiding

174
Q

How much urine can the bladder hold?

A

700-800 ml

175
Q

What happens when the bladder exceeds 300 ml?

A

We get the impulse to urinate

176
Q

What is the radiopharmaceutical 99mTc - MAG3 used for?

A

It is used for imaging purposes

MAG3 has replaced OIH due to superior image quality.

177
Q

What does MAG3 stand for?

A

Mercaptoacetyl Triglycerine

178
Q

Fill in the blank: The radiopharmaceutical 99mTc - _____ is also called Mortiatide.

A

MAG3

179
Q

What are two other radiopharmaceuticals mentioned?

A

99mTc - DTPA, 99mTc - DSMA

180
Q

True or False: The bladder’s shape is constant regardless of the amount of urine.

A

False

181
Q

What is MAG3 used for?

A

Renal function assessment

MAG3 is specifically utilized to evaluate kidney function.

182
Q

What is a key characteristic of MAG3 regarding renal function?

A

It is taken up by the kidneys

MAG3 is absorbed by renal tubular cells, making it useful for studying renal function.

183
Q

How is MAG3 processed in the kidneys?

A

80% tubular secretion and 20% glomerular filtration

This highlights the dual mechanism of MAG3 clearance in renal function.

184
Q

What happens to MAG3 in normal kidneys?

A

Not retained

In healthy kidney function, MAG3 is excreted efficiently and is not retained.

185
Q

What is the typical dose of MAG3 given via injection?

A

5-10 mCi

This dose is administered to evaluate renal function through imaging.

186
Q

What is the process of Iodine-131 clearance from the kidneys?

A

80% via renal tubules and 20% via glomerular filtration

Similar to MAG3, Iodine-131 is also cleared through these two mechanisms.

187
Q

Fill in the blank: Iodine-131 is not used anymore because of _______.

A

low doses and exposure concerns

The risks associated with low doses and potential exposure limits its use.

188
Q

What is the typical dose of Iodine-131 given via injection?

A

0.1 - 0.4 mCi

This lower dose reflects its reduced use in clinical practice.

189
Q

What structure do the renal tubules drain into?

A

Calyxes

The renal tubules transport processed substances into the calyxes, leading to urine formation.

190
Q

In the context of renal function, what does tubular secretion refer to?

A

The process where substances are drawn into tubules

Tubular secretion is a vital part of how kidneys filter blood and produce urine.

191
Q

What is the renal function of iodine?

A

Iodine goes to the kidneys and is excreted by the tubules.

192
Q

What percentage of iodine undergoes glomerular filtration?

A

20% of iodine coming from the blood undergoes filtration.

193
Q

What does Effective Renal Plasma Flow (ERPF) measure?

A

ERPF measures how effectively the kidneys remove a substance from the blood.

194
Q

What does a high value of Effective Renal Plasma Flow (ERPF) indicate?

A

A high value indicates the kidneys are effectively removing that substance from the blood.

195
Q

Fill in the blank: Glucose is not removed from the blood, therefore its ERPF is _______.

A

0

196
Q

Fill in the blank: If iodine is effectively removed from the blood, it will have a high _______.

A

ERPF

197
Q

What is 99m Tc - OTPA cleared from?

A

The kidneys by Glomerular Filtration

198
Q

How is 99m Tc - OTPA taken up and cleared?

A

Rapidly by a normal kidney

199
Q

What does OTPA filter through?

A

The glomerulus of the nephrons

200
Q

Where does OTPA get transported after filtering?

A

To the urine collecting ducts and to the renal pelvis

201
Q

What are the benefits of 99m Tc - OTPA?

A

It is good for:
* Glomerular Filtration Rate
* Function of the kidneys
* Blood flow to the kidney

202
Q

What is another name for 99mTc- DMSA?

A

DiMercaptoSuccinate Acid

203
Q

What is 99mTc- DMSA also called?

A

Succimer

204
Q

How does OSMA interact with the kidneys?

A

It binds to the renal tubules

205
Q

How is OSMA excreted?

A

By Glomerular filtration and tubular secretion

206
Q

What is the function of the renal parenchyma?

A

It refers to the functioning tissue of the kidneys

207
Q

What happens to an area of the kidney that is functioning?

A

It will take up OSMA

208
Q

What is cortical imaging used for?

A

To visualize renal structure around the kidneys

209
Q

What does OMSA bind to?

A

The tubules

210
Q

Where does most of the binding of OMSA occur?

A

In the cortex

211
Q

How long does OMSA remain in the cortex?

A

For an extended period of time

212
Q

What is the typical dose range of 99mTC - OMSA for injection?

A

1-5 mCi

213
Q

How should 99mTC - OMSA be administered?

A

Via IV and injected ASAP after preparation

214
Q

What happens to Santa Gluconaptonate (GH) when it enters the kidneys?

A

Undergoes glomerular filtration

215
Q

What is the fate of most of the GH after entering the kidneys?

A

Quickly excreted from the kidneys

216
Q

What mechanism clears GH from the kidneys?

A

Glomerular Filtration and Tubular Secretion

217
Q

What is a key characteristic of Glucoheptonate (GH) related to renal perfusion?

A

Perfuses well to the kidneys and washes out quickly

218
Q

How is GH beneficial for renal cortex imaging?

A

A small portion remains in the cortex after injection

219
Q

What imaging delay is noted for good visualization of the renal cortex?

A

1-2 hour delay images

220
Q

What is the typical dose range for GH injection?

A

10-20 mCi

221
Q

What is cortical imaging used for?

A

To visualize renal structure around the kidneys

222
Q

What does OMSA bind to?

A

The tubules

223
Q

Where does most of the binding of OMSA occur?

A

In the cortex

224
Q

How long does OMSA remain in the cortex?

A

For an extended period of time

225
Q

What is the typical dose range of 99mTC - OMSA for injection?

A

1-5 mCi

226
Q

How should 99mTC - OMSA be administered?

A

Via IV and injected ASAP after preparation

227
Q

What happens to Santa Gluconaptonate (GH) when it enters the kidneys?

A

Undergoes glomerular filtration

228
Q

What is the fate of most of the GH after entering the kidneys?

A

Quickly excreted from the kidneys

229
Q

What mechanism clears GH from the kidneys?

A

Glomerular Filtration and Tubular Secretion

230
Q

What is a key characteristic of Glucoheptonate (GH) related to renal perfusion?

A

Perfuses well to the kidneys and washes out quickly

231
Q

How is GH beneficial for renal cortex imaging?

A

A small portion remains in the cortex after injection

232
Q

What imaging delay is noted for good visualization of the renal cortex?

A

1-2 hour delay images

233
Q

What is the typical dose range for GH injection?

A

10-20 mCi

234
Q

What is GH in the context of renal imaging?

A

GH is a little more stable than DSMA

GH refers to a contrast agent used in imaging studies.

235
Q

How do larger doses of GH affect perfusion imaging?

A

Larger doses of GH permit better perfusion imaging

This indicates that increased dosage enhances the quality of imaging results.

236
Q

What advantage does GH provide for cortex imaging?

A

GH allows quicker cortex imaging

This is crucial for timely diagnosis and treatment.

237
Q

What are Ronal Procedures?

A

Ronal Procedures encompass various functional renal studies

These procedures are vital for assessing kidney function.

238
Q

What type of studies are included in Functional Renal Studies?

A

Functional Renal Studies include:
* Perfusion Imaging (Piow studies)
* Renal function assessment
* Prenography
* Quantitative Renal Imaging

These studies provide insights into renal health and functionality.

239
Q

What does Effective Renal Plasma Flow (ERPF) measure?

A

ERPF measures the rate of plasma flow through the kidneys

It is a critical parameter in evaluating renal function.

240
Q

What does Glomerular Filtration Rate (GFR) indicate?

A

GFR indicates the rate at which blood is filtered in the kidneys

It is a key indicator of kidney health.

241
Q

What is Ace inhibitor Repography used for?

A

Ace inhibitor Repography is used to assess renal function

It helps in evaluating the effects of ACE inhibitors on the kidneys.

242
Q

What type of imaging does Renal Cortex Imaging involve?

A

Renal Cortex Imaging involves techniques to visualize the kidney cortex

This imaging is essential for diagnosing various renal conditions.

243
Q

What are the key aspects measured in functioning renal studies?

A

Aspects include:
* The radiopharmaceutical uptake by the kidneys
* How the kidneys excrete the radiopharmaceutical

244
Q

What are the indications for conducting functioning renal studies?

A

Indications include:
* Measure renal function
* Renal transplant evaluation
* Evaluate renal blood flow

245
Q

What is the common radiopharmaceutical used in renal studies?

A

Common radiopharmaceuticals include:
* MAG3
* DTPA

246
Q

What is the typical dose range for radiopharmaceuticals in renal studies?

A

Typical dose range is 5-20 mCi

247
Q

What is the recommended patient position during a renal study?

A

Supine

248
Q

What is the camera acquisition view for renal studies?

A

View it till 22 degrees

This refers to the specific angle for optimal imaging.

249
Q

What is the patient preparation required before a renal study?

A

Patient should be well hydrated

250
Q

What are the effects of dehydration on renal studies?

A

Dehydration causes:
* Delay in uptake in kidneys
* Delay in excretion of the kidneys

251
Q

What is the camera acquisition position if evaluating a renal transplant?

A

ANT (anterior)

252
Q

What is the first step in the Plenal Flow procedure?

A

Bous injection of AP IV

253
Q

How often should serial images be acquired in the Plenal Flow procedure?

A

Every 1-5 seconds for led soes

254
Q

What is the timing for acquiring serial sequential images in renal function assessment?

A

30-60 seconds/frame for 20-30 minutes

255
Q

What is the first result observed in renal imaging?

A

Renal perfusion in abdominal aorta

256
Q

When does maximum activity in the kidneys occur during imaging?

A

3-5 minutes

257
Q

Which structures are observed around 5 minutes during renal imaging?

A

Collecting systems (1 calyx and renal pelvis)

258
Q

What follows the imaging of the kidneys in the sequence?

A

The ureters and bladder

259
Q

What happens to kidney activity after the initial peak?

A

Gradually decrease in activity

260
Q

What happens to bladder activity during renal imaging?

A

Increases in activity

261
Q

What is Lasix?

A

Furosemide

262
Q

How can Lasix be administered?

A

Oral or IV injection

263
Q

What is the primary function of Lasix in renal scans?

A

Increase water excretion

264
Q

What type of drug is Lasix?

A

Diuretic

265
Q

What is the purpose of administering Lasix during renal scans?

A

To determine obstruction

266
Q

What is expected in normal kidney function after Lasix is given?

A

Quick excretion of activity

267
Q

What indicates a dilated collecting system in renal imaging?

A

A rise in activity and excretion

268
Q

What characterizes abnormal kidney function with obstruction after Lasix?

A

Gradual increase in kidney activity with no excretion

269
Q

What is the primary preparation needed for a patient undergoing renal imaging?

A

The patient’s bladder should be emptied

A full bladder can stop the flow of urine to the kidneys.

270
Q

When should the administration of the radiopharmaceutical occur in relation to kidney activity?

A

When the collecting systems are full of activity

271
Q

How long after injection should effects of LaSiA start to be observed?

A

2-3 minutes post injection

272
Q

What is the typical dosage of LaSiA for adults?

A

40 mg

273
Q

What is the dosage of LaSiA for pediatric patients?

A

1 mg/kg

274
Q

When do maximum effects of LaSiA occur after administration?

A

15 minutes past injection

275
Q

What does renography apply to a functional renal scan?

A

A time-activity curve (TAC)

276
Q

What does a time-activity curve (TAC) measure?

A

The activity that flows into, is taken up by, and is excreted by the kidneys

277
Q

What type of radiopharmaceutical is needed for renal imaging?

A

An RP that is cleared by tubular secretion

278
Q

Name two examples of radiopharmaceuticals used in renal imaging.

A
  • MAG3
  • OIH
279
Q

What does TAC stand for in renal studies?

A

TAC stands for Time-Activity Curve

It is used to evaluate kidney function.

280
Q

What are the three phases of a TAC?

A

The three phases of a TAC are:
* Vascular
* Secretory
* Excretion

281
Q

What occurs during the Vascular phase of the TAC?

A

Immediate perfusion to kidneys

This phase lasts for approximately 10 seconds.

282
Q

During which phase of the TAC does concentration in tubules occur?

A

Secretory phase

This phase begins at 2 minutes and lasts for 1-5 minutes.

283
Q

What is the significance of the Peak Transit Time in the TAC?

A

It indicates the maximum concentration of the tracer in the kidneys during the Secretory phase

This is an important metric in assessing kidney function.

284
Q

What happens during the Excretion phase of the TAC?

A

A rapid drop in the curve occurs as activity is excreted from the kidney

This phase contains the Peak - Half Time.

285
Q

Fill in the blank: The Vascular phase of the TAC lasts for _______.

A

10 seconds

286
Q

True or False: The Excretion phase is characterized by an increase in activity in the collecting system.

A

False

The Excretion phase shows a rapid drop in the curve.

287
Q

What is the PeaK Transit Time?

A

Peak activity occurs at 3-5 minutes

It refers to the time to peak activity.

288
Q

What is Peak Half Time?

A

Time for half of the peak activity to be excreted from the kidney

Should occur within 7-15 minutes after the peak transit time.

289
Q

What does Split Renal Function measure?

A

A % index of each kidney’s function

Normal function is 50% for the right kidney and 50% for the left kidney.

290
Q

What is considered abnormal in Split Renal Function?

A

A deviation of + or - 10% from 50%

For example, 40% right and 60% left is abnormal.

291
Q

What is Differential Function?

A

Percent of activity remaining in each kidney after 15 minutes

The values for each kidney should be equal; any deviation of 15% is abnormal.

292
Q

What is the maximum count ratio at 20 minutes?

A

The % of peak activity for each kidney at 20 minutes

Each kidney has its own percentage; as the percentage increases, renal function decreases.

293
Q

Fill in the blank: A 35% right and 65% left function is considered _______.

A

abnormal

294
Q

What percentage indicates normal Split Renal Function?

A

50% for the right kidney and 50% for the left kidney

295
Q

True or False: Each kidney’s peak activity percentage at 20 minutes can be compared to each other.

A

False

Each kidney has its own percentage that is not compared to the other.

296
Q

What does quantitative renal imaging include?

A

Effective Renal Plasma Flow (ERPF) and Glomerular Filtration Rate (GFR)

These measurements assess kidney function.

297
Q

What does Effective Renal Plasma Flow (ERPF) measure?

A

The rate that para-aminohippurate (PAH) is filtered and secreted by the tubules

ERPF is expressed in ml/min.

298
Q

What does Glomerular Filtration Rate (GFR) measure?

A

The rate that insulin is filtered from the blood

GFR is also expressed in ml/min.

299
Q

What are the indications for measuring Effective Renal Plasma Flow?

A

Measures the rate PAH is filtered and excreted in the kidneys

This helps evaluate renal function.

300
Q

What radiopharmaceuticals are used in quantitative renal imaging?

A

MAG3 and OIH

Both mimic the filtration and excretion of PAH.

301
Q

What is the patient preparation required for quantitative renal imaging?

A

No patient prep

This simplifies the process for patients.

302
Q

True or False: GFR and ERPF are both expressed in ml/min.

A

True

Both measurements provide a rate of kidney function.

303
Q

What is the first step in the procedure for measuring GFR?

A

Take a pre-injection syringe count

304
Q

What is the purpose of injecting the radiopharmaceutical?

A

To measure Glomerular Filtration Rate (GFR)

305
Q

How long should serial acquisitions be taken after the injection?

A

30 seconds for each frame for 20-30 minutes

306
Q

What is done after taking the serial acquisitions?

A

Take a post injection syringe count

307
Q

Is a blood sample mandatory in the procedure?

A

No, a 45 min blood sample is optional

308
Q

What do the counts left in the kidneys and bladder represent?

A

The activity that is being cleared

309
Q

What do the counts from the blood sample represent?

A

Activity that has not been cleared from the kidneys

310
Q

What is the primary indication for the procedure?

A

Measurement of GFR

311
Q

What radiopharmaceutical is used in the procedure?

A

OTPA, which is entirely excreted by glomerular filtration

312
Q

What is the patient preparation required for this procedure?

A

No patient prep

313
Q

What is the optional time frame for taking a blood sample after the procedure?

A

180 minutes

314
Q

What do the counts of IGA in the kidneys and bladder represent?

A

The activity that is and has been filtered

IGA stands for Immunoglobulin A, and its counts indicate the filtering efficiency of the kidneys.

315
Q

What do the counts taken from the blood sample represent?

A

The activity that has not been filtered by the kidneys

316
Q

What is the purpose of AGE Inhibitor honography?

A

To determine if BAS is causing RUH

317
Q

What do PAS and RVH stand for?

A

PAS = Renal Artery Stenosis / RVH = Renal vascular Hypertension

318
Q

Which radiopharmaceuticals have higher sensitivity and specificity?

A

MAG3 + OIH

MAG3 (Mercaptoacetyltriglycine) and OIH (O-iodohippurate) are used for renal imaging.

319
Q

Which radiopharmaceutical has little specificity and sensitivity?

A

DTPA

320
Q

What is a key patient preparation step before the procedure?

A

Patient should be well hydrated

321
Q

What should a patient discontinue before the procedure?

A

ACE inhibitor medications

322
Q

How long should a patient be NPO before the procedure if using Captopril?

A

4 hours

323
Q

What is the dosage range for Captopril?

A

25-50 mg given orally with water

324
Q

When does peak performance of Captopril occur?

A

At 60 minutes

325
Q

How long must blood pressure be monitored after administering Captopril?

A

For 60 minutes

326
Q

Fill in the blank: Imaging can’t begin until ______ minutes after administering Captopril.

A

60

327
Q

True or False: Two different ACE inhibitor medications can be given.

A

True

328
Q

What is Enalaprilat also known as?

A

Vasotec

329
Q

What is the maximum dose of Enalaprilat?

A

2.5 mg

330
Q

What is the delay needed before administering Mass?

A

10 mins

331
Q

What are the two studies that consist of AGE Inhibitor?

A
  • Baseline and AGE inhibitor study
  • Baseline Procedure
332
Q

What is the first step in the Baseline Procedure?

A

Bolu injection of the RP

333
Q

How long should the flow study acquisition take in the Baseline Procedure?

A

2-3 sec/frame for laD seas

334
Q

What is the duration for acquiring serial static images in the Baseline Procedure?

A

30 secs/image for 29 mins

335
Q

What is the first step in the ACE inhibitor study?

A

Administer the proper ACE inhibitor

336
Q

How long should the wait be after administering the ACE inhibitor?

A

The appropriate amount of time

337
Q

What is the second step in the ACE inhibitor study?

A

Bolus injection of the RP

338
Q

How long should the flow study acquisition take in the ACE inhibitor study?

A

2-3 sec/frame for 100 seconds

339
Q

What is the duration for acquiring serial static images in the ACE inhibitor study?

A

30 secs/image for 29 mins

340
Q

Fill in the blank: Enalaprilat is administered in a dosage of _______.

A

40 ug/1g

Nuclear Med Class 2024 (15 decks)

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