Juichi Kawamura

Validity of 99mTc Dimercaptosuccinic Acid Renal Uptake for an Assessment of Individual Kidney Function

99mTc dimercaptosuccinic acid is a new renal scanning agent that provides a good quality of renal image as a result of preferential cortical accumulation and also makes feasible a quantitative assessment of separate kidney function, correlating well with renal plasma flow obtained from a 131I hippuran renogram of each kidney. By measuring the dimercaptosuccinic acid uptake, the cortical functioning nephrons can be determined independent of the activity from the urinary outflow tract. Such evaluations may replace the conventional split renal function study in which traumatic procedures, such as cystoscopy and ureteral catheterizations, are required. 99mTc dimercaptosuccinic acid scintigraphy causes less discomfort to the patient and can be performed repeatedly and routinely even in children and debilitated geriatric patients.

Choriocarcinoma and Undifferentiated Cell Carcinoma of the Bladder with Gonadotropin Secretion

A case of choriocarcinoma and undifferentiated cell carcinoma of the bladder is reported. Transitional cell carcinoma was found initially in the bladder wall and in the terminal stage there was clinical evidence of production of gonadotropin. The concept of choriocarcinoma mimicry would supplant the explanation for the pathological features in this case.

Bladder carcinoma associated with ectopic production of gonadotropin

A rare incidence of a primary gonadotropin‐producing bladder carcinoma in which gynecomastia appeared in the terminal stage was encountered in a 76‐year‐old Japanese male. There was a good probability that the symptoms of hormonal activity were due to chorionic gonadotropin (hCG), since its whole molecule, β‐ and α‐subunits were detected by radioimmunoassay in the blood, urine, and the tissue from the malignant neoplasm, and the plasma and urine estrogens were elevated. Recent papers concerning the synthesis of hCG‐like material by neoplastic cells are reviewed and the implication of the measurement of β‐ and α‐subunits of hCG in various neoplastic diseases are discussed. Other characteristic profiles of plasma hormonal levels are also discussed in this case. Cancer 42:2773–2780, 1978.

Preoperative and Postoperative Cortical Function of the Kidney with Staghorn Calculi Assessed by 99mTechnetium-Dimercaptosuccinic Acid Renal Scintigraphy

99mTechnetium dimercaptosuccinic acid renal scintigraphy, consisting of the cortical image and dimercaptosuccinic acid renal uptake rate, was used to assess preoperative and postoperative renal function in 55 patients with staghorn calculi. In 14 of 20 patients who had undergone extended pyelolithotomy and in 4 of 22 who had undergone nephrolithotomy there was an increase or no change in the postoperative dimercaptosuccinic acid renal uptake in the surgically treated kidney. However, there was no increase in the postoperative dimercaptosuccinic acid renal uptake in the patients who had undergone pyelolithotomy combined with nephrotomy or partial nephrectomy. Eight per cent of the preoperative dimercaptosuccinic acid renal uptake rate in the diseased kidney seems to be the absolute level for predicting the postoperative recovery of renal function. Dimercaptosuccinic acid renal images provide evidence of morphological changes in the cortex of the kidney with stones and the dimercaptosuccinic acid uptake rate is a useful adjunct for quantitative assessments of preoperative and postoperative residual cortical function.

Transient anuria following administration of angiotensin I-converting enzyme inhibitor (SQ 14225) in a patient with renal artery stenosis of the solitary kidney successfully treated with renal autotransplantation.

We report on a patient with renal artery stenosis who had only 1 kidney and in whom acute renal impairment developed with transient anuria after the administration of captopril. Although inhibition of the angiotensin-converting enzyme is considered to be efficient treatment for hypertension associated with chronic renal failure, care should be taken when captopril is administered initially to a patient with decreased renal function, under the conditions of sodium and water depletion. The renovascular hypertension in this patient was treated successfully by renal autotransplantation.

In vivo estimation of renal volume using a rotating gamma camera for 99mTc-dimercaptosuccinic acid renal imaging

The in vivo renal volume was determined using SPECT for 99mTc-DMSA renal imaging. The total renal volume was derived by summing the DMSA distribution volumes of the transaxial slices in the whole kidney. In 20 healthy subjects the renal volume in the right kidney was 220 ml for men and 195.2 ml for women, while that in the left kidney was 213 ml for men and 193.7 ml for women. Differences in those values were not statistically significant. A good correlation was found between renal volumes in both kidneys and body surface area. In 106 kidneys including solitary and pathological kidneys, individual renal volume correlated well with individual DMSA renal uptake rate which demonstrates cortical functioning mass, depending on the cortical blood flow. Thus, SPECT enables an accurate noninvasive means of estimating in vivo functioning renal volume.

Nephrotoxicity of cis-diamminedichloroplatinum (II) (cis-platinum) and the additive effect of antibiotics: Morphological and functional observation in rats

Basic morphological and functional patterns of cis-platinum nephrotoxicity and the additive effect of combined antibiotics were investigated in male Wistar rats. Nephrotoxicity by cis-platinum is produced in a dose-related fashion and characterized by tubular damage primarily involving the corticomedullary junction. Partial recovery of renal function accompanied by diuresis occurs in 2–3 weeks, however, glomerular filtration rate (GFR) remains at low levels. Histologically, patchy areas of cystic changes remains in the inner cortex, among the areas of relatively normal nephrons. Concomitant use of antibiotics such as aminobenzyl penicillin, sulbenicillin, and cephalothin had no additive effect on platinum nephrotoxicity, from morphological and functional aspects. However, a combination of tobramycin and cis-platinum induced severe renal damage with most animals showing a continuous elevation of blood urea nitrogen and decrease in body weight before death. Histologically, acute tubular necrosis involving both inner and outer cortices was evident. Although cis-platinum is clinically used under enhanced diuresis, GFR and tubular damage have to be carefully monitored throughout the course of cis-platinum treatment. When nephrotoxic antibiotics are being concomitantly prescribed for patients already ingesting cis-platinum, then special precautions should be taken.

Hypertension with elevated renal vein renin secondary to unilateral hydronephrosis

A case of hypertension secondary to unilateral hydronephrosis is reported. Renin levels were elevated in peripheral veins and in the renal vein draining the affected kidney. An infusion of angiotensin II analogue resulted in a decrease in blood pressure. After nephrectomy, blood pressure and peripheral plasma renin activity returned to normal. Renal vein renin and angiotensin II analogue studies were useful in the diagnosis and evaluation of curability by surgery in this case.

Acute Effects of Salmon Calcitonin on Renal Electrolyte Excretion in Intact, Thyroparathyroidectomized and Sulfacetylthiazole-Induced Uremic Rats

Acute effects of salmon calcitonin (CT) on renal electrolyte excretion were investigated in intact, thyroparathyroidectomized (TPTX) and uremic rats. Glomerular filtration rate did not change during CT infusion and there was no volume expansion in any experimental group. Plasma calcium levels gradually fell below the control period in each experimental group. Urinary calcium excretion increased at the early period in both intact and TPTX rats but fell below the control period with the continuous infusion of CT. In uremic rats, a decrease in plasma calcium was followed by a decrease in calcium excretion. Plasma phosphate gradually decreased and simultaneously measured phosphate excretion increased in both intact and TPTX rats. In uremic rats, however, there was no change in phosphate excretion and only a slight decrease of plasma phosphate. Phosphaturia is the result of the predominant renal action of CT and occurs even when the filtered load of phosphate decreases. In uremic animals, there appears to be a resistance to exogenous CT which manifests itself by the absence of natriuretic, calciuric and phosphaturic responses.

“Hot spot” on gallium-67-citrate scan in renal cell carcinoma Clinicopathologic and biochemical correlation

A frontal tomographic whole-body gallium-67-citrate scan was performed on 30 patients with renal cell carcinoma. Positive gallium uptake by the kidney in 20 patients (66.7%) correlated well with the clinicopathologically higher stage and grade of the tumor and with abnormal values in prognostic indexes in the blood. Thus, a negative gallium uptake may be indicative of an improved clinical course and longer survival in patients with renal cell carcinoma.