Renal Study Guide Flashcards
(340 cards)
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
2
Q
The kidneys lie more _______.
A
Posterior
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
4
Q
What connects the renal pelvis to the bladder?
A
The renal pelvis drains into the ureters into bladder
5
Q
What is the functional unit of the kidney?
A
The functional unit of the kidneys is the nephrons
6
Q
What are the three main functions of the nephrons?
A
The three main functions of the nephrons are:
* filtration
* secretion
* reabsorption
7
Q
Where are the nephrons located within the kidney?
A
Nephrons are located within the renal cortex
8
Q
True or False: Nephrons can regenerate.
A
False
9
Q
The number of nephrons you have are _______.
A
constant from birth
10
Q
How are GFR and BP related?
A
GFR and BP are directly related
If blood pressure increases, the GFR also increases.
11
Q
What is a normal GFR?
A
125 ml/min
12
Q
The kidneys produce and secrete _______ which helps regulate BP.
A
renin
13
Q
What are two common agents used for functional renal imaging?
A
99mTc-MAG3 or 99mTc-DTPA
14
Q
What are the most common agents used for morphologic renal imaging?
A
99mTc-GH or 99mTc-DSMA
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.
16
Q
What does ACE stand for?
A
Angiotensin Converting Enzymes
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
18
Q
What is the best view for demonstrating a horseshoe kidney?
A
Anterior view
19
Q
A neobladder made from a portion of the small bowel is called _______.
A
Dead loop
20
Q
Angiotensin II through all its functions, has a (raises/lowers) BP.
A
Raises blood pressure
21
Q
Kidney stones consist of _______.
A
Crystallized salts, calcium oxalate, calcium phosphate
22
Q
What is the ‘commercial’ name for MAG3?
A
Mertiatide
23
Q
What does ERPF stand for?
A
Effective Renal Plasma Flow
24
Q
If normal ERPF is about 600ml/min, what is the normal GFR?
A
120 ml/min
25
What is the ratio of GFR to ERPF?
20%
26
What is ERPF a measure of?
How effectively the kidneys remove a substance from the blood
27
Which statement is true: MAG3 is cleared from the body by glomerular filtration or by tubular secretion?
Both statements are true; MAG3 is mainly cleared by tubular secretion (80%)
28
How is DTPA removed from the kidneys?
DTPA is cleared from the kidneys by glomerular filtration. It is rapidly taken up and cleared by a normal kidney.
29
What are the dose ranges for DMSA and GH?
1-5 mCi for DMSA and 10-20 mCi for GH.
30
Absolute renal function typically refers to the _______.
GFR
31
List a few advantages of GH over DMSA.
* GH is a little more stable than DMSA
* Larger doses of GH permit better perfusion imaging
* GH allows quicker cortex imaging
32
What role would dehydration play in a patient undergoing a functional renal study?
Dehydration causes a delay in uptake in the kidneys and a delay in excretion of the kidneys.
33
How does Lasix administration during a renal scan help rule out or confirm an obstruction?
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.
34
What is an adult dose of Lasix and a pediatric dose?
An adult dose of Lasix is 40 mg and 1 mg/kg for a pediatric dose.
35
What is indicated by a clearance half-time of less than 10 minutes after furosemide injection in a diuretic renal imaging study?
dilated but unobstructed kidney
## Footnote
This suggests that the kidney is functioning but has dilation without obstruction.
36
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?
suspect this to be normal
## Footnote
A normal renogram indicates proper kidney function and tracer uptake.
37
When should Lasix be administered during a renal scan?
15 minutes post injection
## Footnote
Timing is critical for assessing renal function accurately.
38
When do the maximum effects of Lasix occur?
15 minutes past injection
## Footnote
This timing is essential for evaluating the diuretic's impact on kidney function.
39
What are the three phases of the time activity curve in renal imaging?
vascular, secretory, excretory
## Footnote
These phases represent different processes of kidney function.
40
Name two ACE-inhibitor medications used for ACE-inhibitor renography.
Captopril, Enalaprilat (Vasotec)
## Footnote
These medications are used to evaluate renal function through imaging.
41
What can morphologic renal imaging document?
CFR and ERPE
## Footnote
CFR refers to the cortical filtration rate, and ERPE refers to the excretory renal pelvis evaluation.
42
What should a technologist do when a patient is scheduled for an indirect cystogram?
prepare the tracer dose for intravenous injection
## Footnote
Proper preparation is crucial for the success of the imaging procedure.
43
What is the biggest advantage of Vasotec over Captopril in imaging?
Imaging can start after 10 minutes with Vasotec, while with Captopril, you have to wait 60 minutes
## Footnote
This advantage facilitates quicker diagnostic procedures.
44
What effects do ACE inhibitors have in an ACE inhibitor Renography?
They stop the production of Angiotensin I being converted to Angiotensin II, preventing vasoconstriction, thirst, aldosterone, and ADH effects
## Footnote
This results in lower blood pressure and decreased GFR.
45
How will a kidney affected by RAS appear on a nuclear scan after the administration of Vasotec or Captopril?
There will be a delayed washout of activity due to decreased glomerular filtration from reduced blood flow
## Footnote
This will show a delay in uptake and washout in the images.
46
What is the normal split renal function for each kidney?
Each kidney should contribute at least 50% with a deviation of no more than plus/minus 10%
## Footnote
This indicates balanced renal function between the kidneys.
47
True or False: Renal Cell carcinoma generally shows increased concentration of DMSA and GH compared with normal surrounding renal parenchyma.
False
## Footnote
Renal cell carcinoma may have reduced uptake due to loss of normal renal tissue function.
48
What should be visualized within 3 minutes on a normal renal scan?
The renal pelvis and collection system
49
What substance is traditionally used to determine the GFR by non-nuclear medicine techniques?
Creatinine/inulin
50
What is creatinine?
A waste product formed from the normal breakdown of muscle tissue
51
What is inulin?
A polysaccharide that is filtered at the glomerulus but not metabolized by the body
52
Why is inulin not commonly used in clinical practice?
Due to practical difficulties
53
What is the simplest way to reduce exposure to the bladder after a radionuclide renal study?
Voiding regularly
54
What is the major factor that determines if a substance is filtered by the kidneys?
Molecular size
55
What is the purpose of renal imaging?
To differentiate between a dilated renal collecting system and an obstructed renal collecting system
56
What diuretic is used in renal imaging to assess the collecting system?
Lasix
57
What is 99TCM - Gluconeptonate used for?
Renal perfusion imaging
## Footnote
It is indicated for assessing kidney function.
58
What is the typical dose range for 99TCM - Gluconeptonate?
10-20 mCi
## Footnote
This range is used for optimal imaging results.
59
What imaging does 99TCM - Gluconeptonate facilitate?
Cortex imaging
## Footnote
It allows for quicker imaging of the renal cortex.
60
How is 99TCM - Gluconeptonate cleared from the body?
By GFR and tubular secretion
## Footnote
This indicates its elimination processes in the kidneys.
61
What is the effect of a bigger dose of 99TCM - Gluconeptonate?
Quicker cortex imaging
## Footnote
Higher doses can enhance the speed of imaging results.
62
What is 99TEm - ОТРА used for?
GFR assessment
## Footnote
It is used to evaluate kidney function and blood flow.
63
What is the typical dose range for 99TEm - ОТРА?
10-20 mCi
## Footnote
This dosage is standard for effective imaging.
64
What does GFR stand for?
Glomerular filtration rate
## Footnote
It is a key indicator of kidney function.
65
What does aqTEm - OMSA target in the kidneys?
Renal parenchyma
## Footnote
It assesses the functional aspects of the kidneys.
66
What is the typical dose range for aqTEm - OMSA?
1-5 mCi
## Footnote
This lower dose is used for specific imaging needs.
67
What does cortical imaging with aqTEm - OMSA involve?
GFR and tubular secretion
## Footnote
It evaluates both the filtration and secretion capabilities of the kidneys.
68
What does aqTEm - OMSA bind to?
Tubules
## Footnote
This binding is crucial for assessing kidney function.
69
Where does DSMA remain during imaging?
In the cortex
## Footnote
This retention allows for better visualization of renal structures.
70
What does I-131 or I-123-OIH refer to?
Radioactive isotopes used in renal imaging
## Footnote
I-131 and I-123-OIH are used in diagnostic procedures to evaluate kidney function.
71
What are renal tubules?
The structures in the kidneys that reabsorb water and nutrients
## Footnote
Renal tubules play a critical role in urine formation and electrolyte balance.
72
What does GFR stand for?
Glomerular Filtration Rate
## Footnote
GFR is a test used to check how well the kidneys are filtering blood.
73
What is 99mTc-MAG3?
A radiopharmaceutical used for renal imaging
## Footnote
99mTc-MAG3 is commonly used to assess renal function and blood flow.
74
What does renal function refer to?
The ability of the kidneys to filter blood and produce urine
## Footnote
Renal function is crucial for maintaining homeostasis and electrolyte balance.
75
What is the typical dosage range for 99mTc-MAG3 in renal imaging?
5 - 10 mCi
## Footnote
This dosage is standard for effective renal imaging without excessive radiation exposure.
76
True or False: MAG3 is retained by normal kidneys.
False
## Footnote
MAG3 is not retained by normal kidneys and is excreted in urine.
77
What is the relationship between GFR and renal tubules?
GFR + Tubules indicates the combined assessment of filtration and reabsorption
## Footnote
Understanding both GFR and tubule function is essential for evaluating overall renal health.
78
What does the body produce as waste from metabolizing nutrients?
CO2, excess H2O, and heat
79
What are the toxic nitrogenous wastes produced from protein catabolism?
NH3 (ammonia) and urea
80
What are examples of essential ion wastes?
* Na (sodium)
* Cl- (chloride)
* SO4 (sulfate)
* HPO4 (phosphate)
* H (hydrogen)
81
Which organ is primarily involved in eliminating water, nitrogenous wastes, some bacterial toxins, hydrogen, heat, and CO2?
Kidneys
82
What do the lungs primarily eliminate?
CO2, heat, and a little H2O
83
What substances does the skin eliminate?
Heat, H2O, CO2, salts, and urea
84
What does the GI tract eliminate?
Solid undigested wastes, CO2, H2O, salts, and heat
85
Fill in the blank: The body produces _______ from metabolizing nutrients.
CO2, excess H2O, and heat
86
True or False: The kidneys are involved in eliminating heat.
True
87
What are the waste products of protein catabolism?
NH3 (ammonia) and urea
88
What are the kidneys?
Paired reddish organs shaped like kidney beans
## Footnote
Kidneys are essential organs in the body that filter blood and produce urine.
89
Where are the kidneys located?
Just above the waist (posterior)
## Footnote
The kidneys are positioned in the retroperitoneal space.
90
How long and wide are the kidneys?
4-5 inches long, 2-3 inches wide, 1 inch thick
## Footnote
This size can vary slightly between individuals.
91
What is the hilus of the kidney?
Indentation where ureters, blood vessels, and lymphatic vessels enter and exit
## Footnote
The hilus is crucial for the kidney's vascular and urinary connections.
92
What is the first part of the kidney?
Capsule
## Footnote
The capsule is the outer layer that surrounds and protects the kidney.
93
What does the renal capsule do?
Directly covers the kidney
## Footnote
It provides structural support and protection.
94
What is the second part of the kidney?
Cortex
## Footnote
The cortex is the outer reddish area of the kidney.
95
What is contained in the cortex?
Blood vessels and renal tubules
## Footnote
The cortex plays a key role in filtering blood and forming urine.
96
What is the third part of the kidney?
Medulla
## Footnote
The medulla is the inner region of the kidney.
97
What structures are found in the medulla?
8-18 cone-shaped renal pyramids
## Footnote
These pyramids are essential for urine collection and transportation.
98
What are renal pyramids?
Cone-shaped structures within the medulla
## Footnote
Renal pyramids contain blood vessels and tubules that extend from the cortex.
99
How do renal tubules relate to renal pyramids?
They start in the cortex and extend to the pyramids
## Footnote
This connection is vital for urine formation and flow.
100
What is the part of the kidneys that collects urine drained from the calyx?
Pelvis
## Footnote
The pelvis is located at the ends of the calyx.
101
What structure drains urine from the renal pelvis to the bladder?
Ureters
## Footnote
Ureters are located at the medial surface of the kidney.
102
What is the blood supply to the kidneys?
Renal arteries
## Footnote
The right and left renal arteries bring 1200 ml/min of blood to the kidneys.
103
What is the functional unit of the kidneys?
Nephron
## Footnote
Nephrons have three main functions: filtration, secretion, and reabsorption.
104
What are the three main functions of the nephron?
* Filtration
* Secretion
* Reabsorption
## Footnote
Filtration removes substances from blood, secretion adds substances to the calyx, and reabsorption returns substances to the blood.
105
Where are nephrons located?
Renal cortex
## Footnote
Afferent arterioles bring blood to the nephrons, which are located in the renal cortex.
106
Fill in the blank: The kidneys have a good _______ supply because they filter the blood.
blood
## Footnote
This indicates the importance of the kidneys in blood filtration.
107
True or False: Blood exits the kidneys through renal arteries.
False
## Footnote
Blood exits through renal veins, not arteries.
108
What is the flow of blood in the kidneys starting from the renal arteries?
* Renal arteries
* Afferent arterioles
* Nephrons
* Renal veins
## Footnote
This flow highlights how blood is processed within the kidneys.
109
What is the role of afferent arterioles in the kidneys?
Bring blood to the nephrons
## Footnote
Afferent arterioles are crucial for supplying blood to the functional units of the kidneys.
110
What is the primary function of nephrons?
Nephrons filter substances out of the blood
## Footnote
This process starts in the renal cortex and continues in the tubules of the renal pyramids.
111
Where does reabsorption take place in the nephron?
Reabsorption takes place in both the cortex and pyramids
## Footnote
Some substances get reabsorbed back into the bloodstream.
112
What occurs at the end of the renal pyramids?
Secretion of urine occurs
## Footnote
Urine produced is secreted from the nephrons into the calyx.
113
Are the number of nephrons constant throughout a person's life?
Yes, the number of nephrons is constant from birth
## Footnote
Nephrons will get larger, but new ones are not created. If damaged, other nephrons can take up the load.
114
What compensatory mechanism occurs if one kidney is removed?
The other kidney will compensate
## Footnote
Eventually, the two original kidneys will adapt to the loss.
115
What is the first step in producing urine?
Glomerular filtration
## Footnote
This involves forcing fluids and dissolved substances of the blood through glomerular capillaries.
116
What is the fluid called that results from glomerular filtration?
Filtrate
## Footnote
It enters the nephron with all the dissolved substances.
117
What is the source of pressure that drives glomerular filtration?
The pressure of blood
## Footnote
This pressure forces fluids and dissolved substances through the glomerular capillaries.
118
What is the normal Glomerular Filtration Rate (GFR)?
125 ml/min
## Footnote
Normal GFR indicates healthy kidney function.
119
How much urine enters the nephrons each day?
180 liters
## Footnote
This amount reflects the total filtrate produced by the kidneys.
120
What is the typical amount of urine excreted from the kidneys each day?
1-2 liters
## Footnote
This is the volume of urine that is actually eliminated from the body.
121
What happens to GFR if blood pressure drops?
GFR drops
## Footnote
A decrease in blood pressure can impair kidney function.
122
What may occur if GFR is too high?
Some needed substances may pass through quickly and not be absorbed
## Footnote
High GFR can lead to nutrient loss in urine.
123
What is the consequence of a low GFR?
Wastes may not be excreted
## Footnote
Low GFR can lead to accumulation of waste products in the body.
124
What is the role of renin in the Angiotensin I pathway?
Renin acts on Angiotensinogen to produce Angiotensin I
## Footnote
Renin is an enzyme produced by the kidneys that regulates blood pressure.
125
What do the liver produce related to the Angiotensin I pathway?
Angiotensinogen
## Footnote
Angiotensinogen is a plasma protein that is converted to Angiotensin I.
126
What converts Angiotensin I to Angiotensin II?
Angiotensin Converting Enzymes
## Footnote
This conversion is crucial for regulating blood pressure and fluid balance.
127
Fill in the blank: The filtrate that forms in all the _______ is crucial for kidney function.
nephrons
128
True or False: A normal GFR indicates that the kidneys are not functioning properly.
False
## Footnote
A normal GFR is a sign of healthy kidney function.
129
What is angiotensin II?
A peptide hormone that regulates blood pressure and fluid balance.
130
What is one of the primary functions of angiotensin II?
Vasoconstriction
## Footnote
Constricts arterioles of the kidneys to raise GFR.
131
How does angiotensin II affect aldosterone secretion?
Stimulates the adrenal cortex to secrete aldosterone.
132
What effect does aldosterone have on the kidneys?
Enhances absorption of Na.
133
What is the result of increased sodium absorption due to aldosterone?
Increases blood volume, blood pressure (BP), and GFR.
134
How does angiotensin II influence thirst?
Acts on the thirst center to increase water intake.
135
What is the role of antidiuretic hormone (ADH) in relation to angiotensin II?
Stimulates the release of ADH, causing kidneys to retain water.
136
What role do the kidneys play in blood pressure regulation?
They have the ability to raise and lower BP.
137
What is one of the functions of the kidneys regarding blood volume and composition?
Removes wastes, including hydrogen, to control blood pH.
138
What hormone do the kidneys secrete to help regulate blood pressure?
Renin.
139
Fill in the blank: Angiotensin II acts to _______ arterioles.
constrict
140
What is Gluconeogenesis?
The formation of glucose from a non-carbohydrate source during fasting
## Footnote
Common non-carbohydrate sources include proteins.
141
What hormone is secreted by the kidneys to stimulate the formation of red blood cells?
Erythropoietin
## Footnote
Erythropoietin is crucial for the production of red blood cells.
142
What is the active form of Vitamin D synthesized in the body?
Calcitriol
## Footnote
Calcitriol helps maintain calcium levels for bones and normal chemical balance in the body.
143
What is Uremia?
The build-up of urea in the blood
## Footnote
Uremia is higher in the advanced stages of kidney failure.
144
What is Glomerulonephritis?
Inflammation of the glomeruli of the kidneys
## Footnote
It leads to a loss of filtering ability in the kidneys.
145
What does Pyelitis refer to?
Inflammation of the renal pelvis
## Footnote
Pyelitis can lead to more severe kidney infections.
146
What is Pyelonephritis?
Inflammation of the nephrons and renal pelvis
## Footnote
Pyelonephritis is a serious kidney infection.
147
What condition is characterized by inflammation of the bladder?
Cystitis
## Footnote
Cystitis can eventually lead to urinary tract infections or kidney infections.
148
What is a Urinary Tract Infection?
Infection in part of the urinary system or large amount of microbes in the urine
## Footnote
Symptoms can include bacteriuria, urethritis, cystitis, and pyelonephritis.
149
What percentage of patients with hypertension is caused by Renovascular Hypertension (RUH)?
1-4%
## Footnote
RUH is primarily due to issues with the kidneys.
150
What is the most common cause of Renovascular Hypertension?
Renal Artery Stenosis (RAS)
## Footnote
RAS is a blockage of the artery to the kidneys.
151
What effect does Renal Artery Stenosis have on renin secretion?
It can cause an increase in renin secretion
## Footnote
Renin helps in the production of Angiotensin I.
152
What is Angiotensin I converted to?
Angiotensin II
## Footnote
This conversion is facilitated by Angiotensin Converting Enzymes (ACE).
153
What role do ACE inhibitors play in hypertension treatment?
They block the production of Angiotensin II
## Footnote
This helps to lower blood pressure.
154
What characterizes Nephrotic Syndrome?
Protein in the urine
## Footnote
Edema can occur in the eyes, ankles, feet, and abdomen.
155
What is renal failure?
Decrease or cessation of glomerular filtration
## Footnote
It can be acute or chronic.
156
What is acute renal failure?
Stops working entirely
## Footnote
It is a sudden loss of kidney function.
157
What is chronic renal failure?
Progressive and usually irreversible decline in GFR
## Footnote
It develops over time and leads to end-stage renal disease.
158
Fill in the blank: Renovascular Hypertension is primarily caused by _______.
Renal Artery Stenosis
159
True or False: Nephrotic Syndrome is characterized by the presence of blood in the urine.
False
## Footnote
Nephrotic Syndrome is characterized by protein in the urine, not blood.
160
What is polycystic disease?
Cysts in the nephrons that deform the nephrons
## Footnote
Polycystic disease is a genetic disorder characterized by the growth of numerous cysts in the kidneys.
161
What are ureters?
Tubes that drain urine from the kidneys to the bladder
## Footnote
Each kidney has one ureter, and they are approximately 10-12 inches long.
162
Where do ureters enter the bladder?
Medially, on the posterior surface
## Footnote
This positioning is significant for the function of the ureters.
163
What physiological feature prevents backflow of urine into the ureters?
The pressure from the filling bladder compresses the ureter openings
## Footnote
This mechanism acts as a physiologic valve.
164
What is backflow of urine into the ureters also called?
Reflux
## Footnote
Reflux can lead to complications such as urinary tract infections (UTIs) and kidney infections.
165
What is a possible problem that can occur in the ureters?
Kidney stones
## Footnote
Kidney stones are also known as renal calculi.
166
What is urolithiasis?
Stones in the urinary tract
## Footnote
Urolithiasis can lead to pain and obstruction in the urinary system.
167
What causes kidney stones to form?
Urine carries crystals of salt which may form into stones
## Footnote
These stones can get stuck in the ureters, causing severe pain.
168
What is the bladder?
A hollow muscular organ
## Footnote
The bladder's shape depends on the amount of urine it contains.
169
What shape is the bladder when it is empty?
Collapsed
170
What shape does the bladder take when it is ½ full?
Spherical
171
What shape does the bladder take when it is more than ½ full?
Pear shaped
172
Do females have smaller or larger bladders compared to males?
Smaller
173
What is urination also known as?
Voiding
174
How much urine can the bladder hold?
700-800 ml
175
What happens when the bladder exceeds 300 ml?
We get the impulse to urinate
176
What is the radiopharmaceutical 99mTc - MAG3 used for?
It is used for imaging purposes
## Footnote
MAG3 has replaced OIH due to superior image quality.
177
What does MAG3 stand for?
Mercaptoacetyl Triglycerine
178
Fill in the blank: The radiopharmaceutical 99mTc - _____ is also called Mortiatide.
MAG3
179
What are two other radiopharmaceuticals mentioned?
99mTc - DTPA, 99mTc - DSMA
180
True or False: The bladder's shape is constant regardless of the amount of urine.
False
181
What is MAG3 used for?
Renal function assessment
## Footnote
MAG3 is specifically utilized to evaluate kidney function.
182
What is a key characteristic of MAG3 regarding renal function?
It is taken up by the kidneys
## Footnote
MAG3 is absorbed by renal tubular cells, making it useful for studying renal function.
183
How is MAG3 processed in the kidneys?
80% tubular secretion and 20% glomerular filtration
## Footnote
This highlights the dual mechanism of MAG3 clearance in renal function.
184
What happens to MAG3 in normal kidneys?
Not retained
## Footnote
In healthy kidney function, MAG3 is excreted efficiently and is not retained.
185
What is the typical dose of MAG3 given via injection?
5-10 mCi
## Footnote
This dose is administered to evaluate renal function through imaging.
186
What is the process of Iodine-131 clearance from the kidneys?
80% via renal tubules and 20% via glomerular filtration
## Footnote
Similar to MAG3, Iodine-131 is also cleared through these two mechanisms.
187
Fill in the blank: Iodine-131 is not used anymore because of _______.
low doses and exposure concerns
## Footnote
The risks associated with low doses and potential exposure limits its use.
188
What is the typical dose of Iodine-131 given via injection?
0.1 - 0.4 mCi
## Footnote
This lower dose reflects its reduced use in clinical practice.
189
What structure do the renal tubules drain into?
Calyxes
## Footnote
The renal tubules transport processed substances into the calyxes, leading to urine formation.
190
In the context of renal function, what does tubular secretion refer to?
The process where substances are drawn into tubules
## Footnote
Tubular secretion is a vital part of how kidneys filter blood and produce urine.
191
What is the renal function of iodine?
Iodine goes to the kidneys and is excreted by the tubules.
192
What percentage of iodine undergoes glomerular filtration?
20% of iodine coming from the blood undergoes filtration.
193
What does Effective Renal Plasma Flow (ERPF) measure?
ERPF measures how effectively the kidneys remove a substance from the blood.
194
What does a high value of Effective Renal Plasma Flow (ERPF) indicate?
A high value indicates the kidneys are effectively removing that substance from the blood.
195
Fill in the blank: Glucose is not removed from the blood, therefore its ERPF is _______.
0
196
Fill in the blank: If iodine is effectively removed from the blood, it will have a high _______.
ERPF
197
What is 99m Tc - OTPA cleared from?
The kidneys by Glomerular Filtration
198
How is 99m Tc - OTPA taken up and cleared?
Rapidly by a normal kidney
199
What does OTPA filter through?
The glomerulus of the nephrons
200
Where does OTPA get transported after filtering?
To the urine collecting ducts and to the renal pelvis
201
What are the benefits of 99m Tc - OTPA?
It is good for:
* Glomerular Filtration Rate
* Function of the kidneys
* Blood flow to the kidney
202
What is another name for 99mTc- DMSA?
DiMercaptoSuccinate Acid
203
What is 99mTc- DMSA also called?
Succimer
204
How does OSMA interact with the kidneys?
It binds to the renal tubules
205
How is OSMA excreted?
By Glomerular filtration and tubular secretion
206
What is the function of the renal parenchyma?
It refers to the functioning tissue of the kidneys
207
What happens to an area of the kidney that is functioning?
It will take up OSMA
208
What is cortical imaging used for?
To visualize renal structure around the kidneys
209
What does OMSA bind to?
The tubules
210
Where does most of the binding of OMSA occur?
In the cortex
211
How long does OMSA remain in the cortex?
For an extended period of time
212
What is the typical dose range of 99mTC - OMSA for injection?
1-5 mCi
213
How should 99mTC - OMSA be administered?
Via IV and injected ASAP after preparation
214
What happens to Santa Gluconaptonate (GH) when it enters the kidneys?
Undergoes glomerular filtration
215
What is the fate of most of the GH after entering the kidneys?
Quickly excreted from the kidneys
216
What mechanism clears GH from the kidneys?
Glomerular Filtration and Tubular Secretion
217
What is a key characteristic of Glucoheptonate (GH) related to renal perfusion?
Perfuses well to the kidneys and washes out quickly
218
How is GH beneficial for renal cortex imaging?
A small portion remains in the cortex after injection
219
What imaging delay is noted for good visualization of the renal cortex?
1-2 hour delay images
220
What is the typical dose range for GH injection?
10-20 mCi
221
What is cortical imaging used for?
To visualize renal structure around the kidneys
222
What does OMSA bind to?
The tubules
223
Where does most of the binding of OMSA occur?
In the cortex
224
How long does OMSA remain in the cortex?
For an extended period of time
225
What is the typical dose range of 99mTC - OMSA for injection?
1-5 mCi
226
How should 99mTC - OMSA be administered?
Via IV and injected ASAP after preparation
227
What happens to Santa Gluconaptonate (GH) when it enters the kidneys?
Undergoes glomerular filtration
228
What is the fate of most of the GH after entering the kidneys?
Quickly excreted from the kidneys
229
What mechanism clears GH from the kidneys?
Glomerular Filtration and Tubular Secretion
230
What is a key characteristic of Glucoheptonate (GH) related to renal perfusion?
Perfuses well to the kidneys and washes out quickly
231
How is GH beneficial for renal cortex imaging?
A small portion remains in the cortex after injection
232
What imaging delay is noted for good visualization of the renal cortex?
1-2 hour delay images
233
What is the typical dose range for GH injection?
10-20 mCi
234
What is GH in the context of renal imaging?
GH is a little more stable than DSMA
## Footnote
GH refers to a contrast agent used in imaging studies.
235
How do larger doses of GH affect perfusion imaging?
Larger doses of GH permit better perfusion imaging
## Footnote
This indicates that increased dosage enhances the quality of imaging results.
236
What advantage does GH provide for cortex imaging?
GH allows quicker cortex imaging
## Footnote
This is crucial for timely diagnosis and treatment.
237
What are Ronal Procedures?
Ronal Procedures encompass various functional renal studies
## Footnote
These procedures are vital for assessing kidney function.
238
What type of studies are included in Functional Renal Studies?
Functional Renal Studies include:
* Perfusion Imaging (Piow studies)
* Renal function assessment
* Prenography
* Quantitative Renal Imaging
## Footnote
These studies provide insights into renal health and functionality.
239
What does Effective Renal Plasma Flow (ERPF) measure?
ERPF measures the rate of plasma flow through the kidneys
## Footnote
It is a critical parameter in evaluating renal function.
240
What does Glomerular Filtration Rate (GFR) indicate?
GFR indicates the rate at which blood is filtered in the kidneys
## Footnote
It is a key indicator of kidney health.
241
What is Ace inhibitor Repography used for?
Ace inhibitor Repography is used to assess renal function
## Footnote
It helps in evaluating the effects of ACE inhibitors on the kidneys.
242
What type of imaging does Renal Cortex Imaging involve?
Renal Cortex Imaging involves techniques to visualize the kidney cortex
## Footnote
This imaging is essential for diagnosing various renal conditions.
243
What are the key aspects measured in functioning renal studies?
Aspects include:
* The radiopharmaceutical uptake by the kidneys
* How the kidneys excrete the radiopharmaceutical
244
What are the indications for conducting functioning renal studies?
Indications include:
* Measure renal function
* Renal transplant evaluation
* Evaluate renal blood flow
245
What is the common radiopharmaceutical used in renal studies?
Common radiopharmaceuticals include:
* MAG3
* DTPA
246
What is the typical dose range for radiopharmaceuticals in renal studies?
Typical dose range is 5-20 mCi
247
What is the recommended patient position during a renal study?
Supine
248
What is the camera acquisition view for renal studies?
View it till 22 degrees
## Footnote
This refers to the specific angle for optimal imaging.
249
What is the patient preparation required before a renal study?
Patient should be well hydrated
250
What are the effects of dehydration on renal studies?
Dehydration causes:
* Delay in uptake in kidneys
* Delay in excretion of the kidneys
251
What is the camera acquisition position if evaluating a renal transplant?
ANT (anterior)
252
What is the first step in the Plenal Flow procedure?
Bous injection of AP IV
253
How often should serial images be acquired in the Plenal Flow procedure?
Every 1-5 seconds for led soes
254
What is the timing for acquiring serial sequential images in renal function assessment?
30-60 seconds/frame for 20-30 minutes
255
What is the first result observed in renal imaging?
Renal perfusion in abdominal aorta
256
When does maximum activity in the kidneys occur during imaging?
3-5 minutes
257
Which structures are observed around 5 minutes during renal imaging?
Collecting systems (1 calyx and renal pelvis)
258
What follows the imaging of the kidneys in the sequence?
The ureters and bladder
259
What happens to kidney activity after the initial peak?
Gradually decrease in activity
260
What happens to bladder activity during renal imaging?
Increases in activity
261
What is Lasix?
Furosemide
262
How can Lasix be administered?
Oral or IV injection
263
What is the primary function of Lasix in renal scans?
Increase water excretion
264
What type of drug is Lasix?
Diuretic
265
What is the purpose of administering Lasix during renal scans?
To determine obstruction
266
What is expected in normal kidney function after Lasix is given?
Quick excretion of activity
267
What indicates a dilated collecting system in renal imaging?
A rise in activity and excretion
268
What characterizes abnormal kidney function with obstruction after Lasix?
Gradual increase in kidney activity with no excretion
269
What is the primary preparation needed for a patient undergoing renal imaging?
The patient's bladder should be emptied
## Footnote
A full bladder can stop the flow of urine to the kidneys.
270
When should the administration of the radiopharmaceutical occur in relation to kidney activity?
When the collecting systems are full of activity
271
How long after injection should effects of LaSiA start to be observed?
2-3 minutes post injection
272
What is the typical dosage of LaSiA for adults?
40 mg
273
What is the dosage of LaSiA for pediatric patients?
1 mg/kg
274
When do maximum effects of LaSiA occur after administration?
15 minutes past injection
275
What does renography apply to a functional renal scan?
A time-activity curve (TAC)
276
What does a time-activity curve (TAC) measure?
The activity that flows into, is taken up by, and is excreted by the kidneys
277
What type of radiopharmaceutical is needed for renal imaging?
An RP that is cleared by tubular secretion
278
Name two examples of radiopharmaceuticals used in renal imaging.
* MAG3
* OIH
279
What does TAC stand for in renal studies?
TAC stands for Time-Activity Curve
## Footnote
It is used to evaluate kidney function.
280
What are the three phases of a TAC?
The three phases of a TAC are:
* Vascular
* Secretory
* Excretion
281
What occurs during the Vascular phase of the TAC?
Immediate perfusion to kidneys
## Footnote
This phase lasts for approximately 10 seconds.
282
During which phase of the TAC does concentration in tubules occur?
Secretory phase
## Footnote
This phase begins at 2 minutes and lasts for 1-5 minutes.
283
What is the significance of the Peak Transit Time in the TAC?
It indicates the maximum concentration of the tracer in the kidneys during the Secretory phase
## Footnote
This is an important metric in assessing kidney function.
284
What happens during the Excretion phase of the TAC?
A rapid drop in the curve occurs as activity is excreted from the kidney
## Footnote
This phase contains the Peak - Half Time.
285
Fill in the blank: The Vascular phase of the TAC lasts for _______.
10 seconds
286
True or False: The Excretion phase is characterized by an increase in activity in the collecting system.
False
## Footnote
The Excretion phase shows a rapid drop in the curve.
287
What is the PeaK Transit Time?
Peak activity occurs at 3-5 minutes
## Footnote
It refers to the time to peak activity.
288
What is Peak Half Time?
Time for half of the peak activity to be excreted from the kidney
## Footnote
Should occur within 7-15 minutes after the peak transit time.
289
What does Split Renal Function measure?
A % index of each kidney's function
## Footnote
Normal function is 50% for the right kidney and 50% for the left kidney.
290
What is considered abnormal in Split Renal Function?
A deviation of + or - 10% from 50%
## Footnote
For example, 40% right and 60% left is abnormal.
291
What is Differential Function?
Percent of activity remaining in each kidney after 15 minutes
## Footnote
The values for each kidney should be equal; any deviation of 15% is abnormal.
292
What is the maximum count ratio at 20 minutes?
The % of peak activity for each kidney at 20 minutes
## Footnote
Each kidney has its own percentage; as the percentage increases, renal function decreases.
293
Fill in the blank: A 35% right and 65% left function is considered _______.
abnormal
294
What percentage indicates normal Split Renal Function?
50% for the right kidney and 50% for the left kidney
295
True or False: Each kidney's peak activity percentage at 20 minutes can be compared to each other.
False
## Footnote
Each kidney has its own percentage that is not compared to the other.
296
What does quantitative renal imaging include?
Effective Renal Plasma Flow (ERPF) and Glomerular Filtration Rate (GFR)
## Footnote
These measurements assess kidney function.
297
What does Effective Renal Plasma Flow (ERPF) measure?
The rate that para-aminohippurate (PAH) is filtered and secreted by the tubules
## Footnote
ERPF is expressed in ml/min.
298
What does Glomerular Filtration Rate (GFR) measure?
The rate that insulin is filtered from the blood
## Footnote
GFR is also expressed in ml/min.
299
What are the indications for measuring Effective Renal Plasma Flow?
Measures the rate PAH is filtered and excreted in the kidneys
## Footnote
This helps evaluate renal function.
300
What radiopharmaceuticals are used in quantitative renal imaging?
MAG3 and OIH
## Footnote
Both mimic the filtration and excretion of PAH.
301
What is the patient preparation required for quantitative renal imaging?
No patient prep
## Footnote
This simplifies the process for patients.
302
True or False: GFR and ERPF are both expressed in ml/min.
True
## Footnote
Both measurements provide a rate of kidney function.
303
What is the first step in the procedure for measuring GFR?
Take a pre-injection syringe count
304
What is the purpose of injecting the radiopharmaceutical?
To measure Glomerular Filtration Rate (GFR)
305
How long should serial acquisitions be taken after the injection?
30 seconds for each frame for 20-30 minutes
306
What is done after taking the serial acquisitions?
Take a post injection syringe count
307
Is a blood sample mandatory in the procedure?
No, a 45 min blood sample is optional
308
What do the counts left in the kidneys and bladder represent?
The activity that is being cleared
309
What do the counts from the blood sample represent?
Activity that has not been cleared from the kidneys
310
What is the primary indication for the procedure?
Measurement of GFR
311
What radiopharmaceutical is used in the procedure?
OTPA, which is entirely excreted by glomerular filtration
312
What is the patient preparation required for this procedure?
No patient prep
313
What is the optional time frame for taking a blood sample after the procedure?
180 minutes
314
What do the counts of IGA in the kidneys and bladder represent?
The activity that is and has been filtered
## Footnote
IGA stands for Immunoglobulin A, and its counts indicate the filtering efficiency of the kidneys.
315
What do the counts taken from the blood sample represent?
The activity that has not been filtered by the kidneys
316
What is the purpose of AGE Inhibitor honography?
To determine if BAS is causing RUH
317
What do PAS and RVH stand for?
PAS = Renal Artery Stenosis / RVH = Renal vascular Hypertension
318
Which radiopharmaceuticals have higher sensitivity and specificity?
MAG3 + OIH
## Footnote
MAG3 (Mercaptoacetyltriglycine) and OIH (O-iodohippurate) are used for renal imaging.
319
Which radiopharmaceutical has little specificity and sensitivity?
DTPA
320
What is a key patient preparation step before the procedure?
Patient should be well hydrated
321
What should a patient discontinue before the procedure?
ACE inhibitor medications
322
How long should a patient be NPO before the procedure if using Captopril?
4 hours
323
What is the dosage range for Captopril?
25-50 mg given orally with water
324
When does peak performance of Captopril occur?
At 60 minutes
325
How long must blood pressure be monitored after administering Captopril?
For 60 minutes
326
Fill in the blank: Imaging can't begin until ______ minutes after administering Captopril.
60
327
True or False: Two different ACE inhibitor medications can be given.
True
328
What is Enalaprilat also known as?
Vasotec
329
What is the maximum dose of Enalaprilat?
2.5 mg
330
What is the delay needed before administering Mass?
10 mins
331
What are the two studies that consist of AGE Inhibitor?
* Baseline and AGE inhibitor study
* Baseline Procedure
332
What is the first step in the Baseline Procedure?
Bolu injection of the RP
333
How long should the flow study acquisition take in the Baseline Procedure?
2-3 sec/frame for laD seas
334
What is the duration for acquiring serial static images in the Baseline Procedure?
30 secs/image for 29 mins
335
What is the first step in the ACE inhibitor study?
Administer the proper ACE inhibitor
336
How long should the wait be after administering the ACE inhibitor?
The appropriate amount of time
337
What is the second step in the ACE inhibitor study?
Bolus injection of the RP
338
How long should the flow study acquisition take in the ACE inhibitor study?
2-3 sec/frame for 100 seconds
339
What is the duration for acquiring serial static images in the ACE inhibitor study?
30 secs/image for 29 mins
340
Fill in the blank: Enalaprilat is administered in a dosage of _______.
40 ug/1g
