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Decreased renal uptake of 99mTc-DMSA in patients with tubular proteinuria

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Abstract

Although technetium-99m-dimercaptosuccinic acid (99mTc-DMSA) renal scans are widely used to evaluate renal tubular mass function, the mechanism by which renal uptake of DMSA occurs is still the subject of debate. Patients with various proximal tubular disorders show markedly decreased renal DMSA uptake, even when there is normal creatinine clearance. We measured the renal uptake of 99mTc-DMSA 3 h after its injection in 13 patients with Dent disease or Lowe syndrome, both of which are typical proximal tubular disorders with defective megalin and cubilin-mediated endocytosis. Serial images of three patients were also obtained at 0.5, 1, 2 and 3 h post-injection. The correlations between renal uptake of 99mTc-DMSA and creatinine clearance and the degrees of acidemia and tubular proteinuria were then evaluated. The renal uptake of 99mTc-DMSA was markedly decreased in all patients, and the decreased uptake was detected in all serial images. In contrast, bladder radioactivity was higher than normal in all of the serial images when compared to renal radioactivity. Additionally, the uptake of 99mTc-DMSA was inversely proportional to the amount of urine β2-microglobulin. These results strongly suggest that DMSA is filtered in the glomeruli and subsequently undergoes megalin- and cubilin-mediated endocytosis in the proximal tubules.

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Acknowledgments

This study was supported by a grant (A080588) from the Korea Healthcare technology R&D Project, Ministry of Health & Welfare, Republic of Korea and a grant (06-2008-192-9) from Seoul National University Hospital.

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Authors and Affiliations

  1. Department of Pediatrics, Seoul National University Children’s Hospital, 28 Yongon-Dong, Chongro-Gu, Seoul, 110-744, South Korea

    Beom Hee Lee, So Hee Lee, Hyun Jin Choi, Hee Gyung Kang, Il Soo Ha, Yong Choi & Hae Il Cheong

  2. Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, South Korea

    Beom Hee Lee, Il Soo Ha, Yong Choi & Hae Il Cheong

  3. Research Center for Rare Diseases, Seoul National University Hospital, Seoul, South Korea

    Hee Gyung Kang & Hae Il Cheong

  4. Department of Nuclear Medicine, Seoul National University Hospital, Seoul, South Korea

    So Won Oh & Dong Soo Lee

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  1. Beom Hee Lee
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Correspondence to Hae Il Cheong.

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Lee, B.H., Lee, S.H., Choi, H.J. et al. Decreased renal uptake of 99mTc-DMSA in patients with tubular proteinuria. Pediatr Nephrol 24, 2211–2216 (2009). https://doi.org/10.1007/s00467-009-1238-2

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  • DOI: https://doi.org/10.1007/s00467-009-1238-2

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