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Tc-99m Hydroxymethylene Diphosphonate (HMDP) Renal Uptake as a Surrogate Marker of Postoperative Impairment of the Glomerular Filtration Rate in Renal Tumor Patients Following Nephron-Sparing Surgery

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Abstract

Purpose: We investigated Tc-99m hydroxymethylene diphosphonate (HMDP) scintigraphy findings in renal tumor patients from the perspective of postoperative renal dysfunction following nephron-sparing surgery (NSS). Methods: Forty-three renal tumor patients (M:F = 28:15, age 53.9 ± 12.5 years) who had undergone Tc-99m HMDP scintigraphy after NSS were enrolled. The patients were divided into HMDP+ or HMDP− groups by visual assessment, and the asymmetric index (ASI) was calculated using a region-of-interest analysis. In 16 patients, the total and split glomerular filtration rate (GFR) was assessed using Tc-99m diethylenetriaminepentaacetic acid (DTPA) scintigraphy at baseline and at 3 and 6 months post-NSS. Results: High Tc-99m HMDP uptake was observed in the operated kidneys, but this did not persist later than 7 days post-NSS. Split GFR of the operated kidneys at baseline (58.5 ± 9.3 ml/min) was significantly reduced at 6 months post-NSS (40.1 ± 5.9 ml/min, p < 0.001) in only those who showed intense uptake of Tc-99m HMDP. Declines in both total GFR (p = 0.010 and p = 0.002 for 3 and 6 months, respectively) and split GFR of the operated kidneys (p < 0.001 and p < 0.001 for 3 and 6 months, respectively) were clearly evidenced at 3 and 6 months post-NSS only in patients with high Tc-99m HMDP in the operated kidneys. The ASI was negatively correlated with %change in the split GFR of these operated kidneys at 6 months post-NSS (rho =−0.578, p = 0.0304). Conclusions: Tc-99m HMDP uptake within 1 week following NSS is a surrogate marker of GFR impairment over 6 months post-NSS.

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Acknowledgments

We are grateful to Sang Eon Kim and Kyung Hoon Kim for their excellent technical assistance during Tc-99m DTPA GFR scintigraphy. This study was supported in part by a grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (A111627-1101-0000100), and by grants from the National Research Foundation (NRF), Ministry of Education, Science and Technology (MEST), Republic of Korea (2012M2B2A9A02029612, 2014M2B2A9030104 and Basic Science Research Program 2012R1A1A2001060).

Ethical Statement

This study was approved by our hospital's ethics committee (IRB no. = B-1310/224-103) and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Obtaining patients’ consent was waived by the ethics committee. Details that might disclose the identity of the subjects were omitted.

Conflict of Interests

Hongyoon Choi, Won Woo Lee, Young So, Seunggyun Ha, Seok-Soo Byun, and Sang Eun Kim declare that there is no conflict of interest.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Seoul, Republic of Korea

    Hongyoon Choi, Won Woo Lee, Seunggyun Ha & Sang Eun Kim

  2. Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea

    Seok-Soo Byun

  3. Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea

    Won Woo Lee & Sang Eun Kim

  4. Department of Nuclear Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea

    Young So

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  1. Hongyoon Choi
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  2. Won Woo Lee
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  3. Young So
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  4. Seunggyun Ha
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  5. Seok-Soo Byun
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Correspondence to Won Woo Lee.

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Choi, H., Lee, W.W., So, Y. et al. Tc-99m Hydroxymethylene Diphosphonate (HMDP) Renal Uptake as a Surrogate Marker of Postoperative Impairment of the Glomerular Filtration Rate in Renal Tumor Patients Following Nephron-Sparing Surgery. Nucl Med Mol Imaging 48, 262–271 (2014). https://doi.org/10.1007/s13139-014-0284-2

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  • DOI: https://doi.org/10.1007/s13139-014-0284-2

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