Issn Print: 0363-9762

Publication Date: 1997/04/01


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CYCLOSPORINE NEPHROTOXICITY AND THE ROLE OF TRIPLE RENAL SCINTIGRAPHY

S. Dadparvar; F. Samimi; S. Ahn; J. Wang; K. M. Kapadia; M. M. Gillan; L. Krishna; W. J. Slizofski

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Excerpt

The introduction of cyclosporin A (CSA) to clinical renal transplantation has been a major development in controlling allograft rejection. The major disadvantage, however, is the nephrotoxic side effect. Clinically, acute CSA nephrotoxicity is difficult to differentiate from acute rejection, and renal biopsy is often needed.
We retrospectively reviewed 17 triple renal scintigrams which were performed on 16 patients with a proven diagnosis of CSA nephrotoxicity, (10 female, 6 male), with an age range of 22-62 yrs, (mean age: 35.3 years) were included in this study. Triple renal scintigraphy was performed following intravenous injection of 5.0mCi Tc99m-DTPA in order to evaluate renal blood flow and glomerular function. Then, 150uCi I-131 Hippuran was injected intravenously to evaluate renal tubular function. Qualitative and quantitative analysis was performed. The renal scintigrams were reviewed by three nuclear medicine physicians without prior knowledge of clinical or biochemical data. The final diagnosis was based on the clinical data, biochemical data and biopsy findings.
Six normal studies were observed with normal renal blood flow at 2-6 seconds, normal perfusion, glomerular and tubular function. Creatinine range was 1.7-7.2mg/dl and cyclosporine range was 307-678ng/ml.
Six studies consistent with acute tubular necrosis were observed with renal blood flow at 4-8 seconds, fair kidney perfusion with persistent tubular uptake throughout the study. Creatinine range was 2.4-11.3mg/dl and cyclosporine range was 271-555ng/nl.
Five studies consistent with acute rejection were observed with renal blood flow at 6-8 seconds, poor kidney perfusion and poor glomerular and tubular function. Creatinine range was 1.7-3.5mg/dl and cyclosporine range was 197-439ng/ml.
We conclude that there are no specific findings on triple renal scintigraphy in patients with CSA nephrotoxicity. However, in the management of patients with cyclosporine nephrotoxicity, sequential triple renal scintigraphy concomitant with clinical and biochemical data could eliminate the need for renal biopsy.
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