Sfakianakis George N, Sfakianaki Efrosyni, Georgiou Mike, Serafini Aldo, Ezuddin Shabbir, Kuker Russ, Zilleruelo Gaston, Strauss Jose, Abitbol Carolyn, Chandar Jayanthi, Seeherunvong Wacharee, Bourgoignie Jacque, Roth David, Leveillee Raymond, Bird Vincent G, Block Norman, Gosalbez Rafael, Labbie Andrew, Guerra Jorge J, Yrizarry Jose
Department of Nuclear Medicine, University of Miami School of Medicine and Jackson Memorial Hospital, Miami, FL 33101, USA.
Semin Nucl Med. 2009 May;39(3):156-73. doi: 10.1053/j.semnuclmed.2008.11.001.
Current clinical requirements mandate the existence of a renal diuretic protocol, which is fast and easy, applicable in all ages and for all indications, convenient for both the patient and the technologist, and provides diagnostic as well as prognostic information. Seventeen years ago a 25-minute protocol, after oral hydration, with no bladder catheterization, and simultaneous injection of mercapto-acetyl-triglycine (MAG(3)) and furosemide (MAG(3)-F(0)), was initiated. It initially was used for the evaluation of drainage and emerged as a protocol to also evaluate the renal parenchyma. Results of this protocol have been published individually, per clinical application. MAG(3)-F(0) was instrumental in the evaluation and prognosis of congenital disorders. For obstruction, in the newborn, an increasing renogram mandates intervention, whereas a downsloping one predicts spontaneous resolution. In children or adults, preoperatively or postoperatively, when the cortex was visualized and drained normally, there was no obstruction, even if urine was retained within a dilated collecting system or an extrarenal pelvis. For diseases of the renal parenchyma, the protocol enabled the diagnosis of acute pyelonephritis (APN) revealing the "regional parenchymal dysfunction," diagnostic of APN. Diffuse parenchymal diseases were characterized by increased residual cortical activity (RCA), and their progression was manifested as a deterioration of RCA. End-stage renal disease was characterized by lack of accumulation and retention. Trauma and leaks were identified with specific patterns. In renovascular hypertension (RVH), an increase in RCA after angiotension-converting enzyme inhibitors is diagnostic of RVH and prognostic of the beneficial effect of angioplasty on hypertension. In renal colic, stratification was possible into (1) complete or severe obstruction requiring immediate intervention, (2) mild obstruction allowing waiting, (3) spontaneous decompression (stunned kidney), and (4) no recent obstruction. In transplants, it enabled differentiation of acute tubular necrosis, acute or chronic rejection and nephrotoxicity, and identified infarcts, RVH, leaks and obstruction. Finally, this method allows for a quick semiquantification of renal function. The clinical usefulness of the MAG(3)-F(0) protocol in most congenital or acquired renal problems is proven through long-term clinical experience and has resulted in a substantial utilization of the test at our Center.
当前的临床需求要求存在一种肾脏利尿方案，该方案要快速简便，适用于所有年龄段和所有适应症，对患者和技术人员都方便，并且能提供诊断和预后信息。十七年前，启动了一种25分钟的方案，即在口服补液后，不进行膀胱插管，同时注射巯基乙酰三甘氨酸（MAG(3)）和呋塞米（MAG(3)-F(0)）。它最初用于评估引流情况，并逐渐成为一种也可评估肾实质的方案。该方案的结果已根据临床应用分别发表。MAG(3)-F(0)在先天性疾病的评估和预后中发挥了重要作用。对于新生儿的梗阻，肾图上升提示需要干预，而下降型则预示可自发缓解。在儿童或成人中，术前或术后，当皮质正常显影和引流时，即使尿液潴留在扩张的集合系统或肾外肾盂内，也不存在梗阻。对于肾实质疾病，该方案能够诊断急性肾盂肾炎（APN），显示出“局部实质功能障碍”，这是APN的诊断依据。弥漫性实质疾病的特征是残余皮质活性（RCA）增加，其进展表现为RCA恶化。终末期肾病的特征是缺乏积聚和潴留。创伤和渗漏可通过特定模式识别。在肾血管性高血压（RVH）中，血管紧张素转换酶抑制剂治疗后RCA增加可诊断RVH，并可预测血管成形术对高血压的有益效果。在肾绞痛中，可分为以下几种情况：（1）需要立即干预的完全或严重梗阻；（2）允许等待的轻度梗阻；（3）自发减压（休克肾）；（4）近期无梗阻。在移植中，它能够区分急性肾小管坏死、急性或慢性排斥反应以及肾毒性，并识别梗死、RVH、渗漏和梗阻。最后，该方法可对肾功能进行快速半定量分析。通过长期临床经验证明，MAG(3)-F(0)方案在大多数先天性或后天性肾脏问题中具有临床实用性，并且在我们中心该检查得到了大量应用。
