Abstract
Dimercaptosuccinic acid labeled with technetium-99m (99mTc-DMSA) has been reported to be a good agent for quantitative estimation of renal function. Its biodistribution is found to be altered in tubular disorders. The aim of the present study was to assess tubular function in diabetic nephropathy patients by studying 99mTc-DMSA biodistribution and to compare the findings obtained with those of primary glomerulonephritis patients. This study included 18 insulin-dependent patients with overt diabetic nephropathy and 16 glomerulonephritis patients with normal serum creatinine levels and moderately decreased glomerular filtration rate. Renal fixation of 99mTc-DMSA and whole blood activity 2 and 4 h following radiopharmaceutical injection, as well as 4 h cumulative urinary excretion were determined. All values were expressed as per cent of net administered activity. 99mTc-DMSA renal accumulation was significantly decreased (p<0.001), while urinary excretion was increased (p<0.005) in both groups examined, as compared to 15 healthy persons. The reduction in 99mTc-DMSA renal fixation was more marked in diabetic nephropathy than in glomerulonephritis (p<0.05). Whole blood activity was markedly higher in diabetic patients (p<0.05), but nonsignificantly increased in glomerulonephritis patients. Markedly decreased tubular fixation of 99mTc-DMSA associated with high blood activity and increased urinary excretion demonstrated more pronounced tubular dysfunction in diabetic nephropathy than in primary glomerulonephritis at the same level of glomerular filtration rate.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Müller-Surr, R., Gutsche, H. R.: Tubular reabsorption of technetium-99m-DMSA. J. Nucl. Med., 36, 1654 (1995).
Lin, T. H., Khentigan, A., Whinchell, H. S.: A 99mTc chelates substitute for organoradiomercurial renal agents. J. Nucl. Med., 15, 34 (1974).
Van Lujik, W. H. J., Ensing, G. J., Piers, D. A.: Low renal uptake of 99mTc-DMSA in patients with proximal tubular dysfunction. Eur. J. Nucl. Med., 8, 404 (1983).
Prvoost, A. P., Van Aken, M.: Renal handling of technetium 99m-DMSA in rats with proximal tubular dysfunction. J. Nucl. Med., 26, 1063 (1985).
Striker, L. J., Doi, T., Striker, G. E.: The contribution of glomerular cells to progressive glomerulosclerosis. Semin. Nephrol., 9, 318 (1989).
Steffes, M. W., Bilous, R. W., Sutherland, D. E. R., Mauer, S. M.: Cell and matrix components of the glomerular mesangium in type I diabetes. Diabetes, 41, 679 (1992).
Ong, A. C. M., Fine, L. G.: Loss of glomerular function and tubulointerstitial fibrosis: Cause or effect? Kidney Int., 45, 345 (1994).
Szabolcs, M. J., Inghami, G., Lic, J., Ward, L., D'Agati, V.: Analysis of cellular proliferation in human glomerulonephritis using KI-67 and PCNA. Am. J. Soc. Nephrol., 4, 690A (1993).
Moretti, J. L., Rapin, J. R., Saccavini, J. C., Lageron, A., Le Poncin, M., Bardy, A.: 2,3-Dimercaptosuccinic-acid chelates-2. Renal localization. Int. J. Nucl. Med. Biol., 11, 275 (1984).
Kim, S. E., Cho, J. T., Lee, D. S.: Poor renal uptake of technetium-99m-DMSA and technetium-99m-MDP in a patient with Fanconi syndrome and near normal glomerular filtration rate. J. Korean Med. Sci., 9, 29 (1994).
Rajić, M., Bogićević, M., Ilić, S., Stefanović, V.: 99mTc-DMS tubular fixation in Balkan endemic nephropathy patients. Nephron, 74, 221 (1996).
Bohle, A., Gise, H., Mackensen-Haen, S., Starker-Jakob, B.: The obliteration of the post-glomerular capillaries and its influence upon the function of both glomeruli and tubuli. Klin. Wochenschr., 59, 1043 (1992).
Fine, L. G., Norman, J. T.: Renal growth responses to acute and chronic injury: Routes to therapeutic intervention. J. Am. Soc. Nephrol., 2, S206 (1992).
Yanagisawa, M., Kurihara, H., Kimura, S.: A novel potent vasoconstrictor peptide produced by vascular endothelial cells. Nature, 332, 411 (1988).
Le Hir, M., Kaissling, B., Gandhi, R., Dubach, U. C.: Fibroblasts may represent the main site of production of interstitial adenosine in the kidney. Kidney Int., 36, 319 (1989).
Marcussen, N.: Atubular glomeruli and the structural basis for chronic renal failure. Lab. Invest., 66, 265 (1992).
Ziyadeh, F. N., Snipes, E. R., Watanabe, M., Alvarez, R. J., Goldfarb, S., Haverty, T. P.: High glucose induces cell hypertrophy and stimulates collagen gene transcription in proximal tubule. Am. J. Physiol., 259, F704 (1990).
Danne, T., Spiro, M. G., Spiro, R. G.: Effect of high glucose on type IV collagen production by cultured glomerular epithelial, endothelial and mesangial cells. Diabetes, 42, 170 (1993).
Cagliero, E., Roth, T., Roy, S., Moriello, M., Lorenzi, M.: Expression of genes related to the extracellular matrix in human endothelial cells: Differential modulation by elevated glucose concentrations, phorbol esters and cAMP. J. Biol. Chem., 266, 14244 (1991).
Mauer, S. M., Steffes, M. W., Ellis, E. N., Sutherland, D. E. R., Brown, D. M., Goetz, F. C.: Structural-functional relationships in diabetic nephropathy. J. Clin. Invest., 74, (1984).
Steffes, M. W., Sutherland, D. E. R., Goetz, F. C., Rich, S. S., Mauer, S. M.: Studies of kidney and muscle biopsy specimens from identical twins discordant for type I diabetes mellitus. N. Eng. J. Med., 312, 1282 (1985).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Rajić, M., Bogićević, M., Ilić, S. et al. 99mTc-dimercaptosuccinic Acid Tubular Fixation in Diabetic Nephropathy Patients. Int Urol Nephrol 31, 839–843 (1999). https://doi.org/10.1023/A:1007118201986
Issue Date:
DOI: https://doi.org/10.1023/A:1007118201986