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*Onleavefromthedepartmento@Medicineanddivi Sion of Nuclear Medicine, Faculty of Medicine, Cairo Uni Apertures; the Crystal Was Recessed 3 In

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*Onleavefromthedepartmento@Medicineanddivi Sion of Nuclear Medicine, Faculty of Medicine, Cairo Uni Apertures; the Crystal Was Recessed 3 In INTERRELATIONSHIP BETWEEN HYDRATION, URINE FLOW, RENAL BLOOD FLOW AND THE RADIOHIPPURAN RENOGRAM Muhammad A. Razzak,* Robert E. Both and William J. Maclntyre Case Western Reserve University, Cleveland, Ohio Soonafter the introductionof radioisotoperenog surface. The counting rate from each detector was raphy, it became evident that the shape of the tracing recordedby an integratingprinting scaleractivated obtained varied with the state of hydration of the at 15-sec intervals over a period of 30 mm. To start subject examined. Nevertheless, there has been no with, the study was performed after an overnight overall agreement about the preferred state of hy fast; then it was repeated following the intake of the dration under which to perform the renogram. Some water load. In the second determination the dose of workers believe that hydration gives better distinc radiohippuran was doubled. tion between normal and abnormal (1 ,2 ) , whereas At the end of the study, each subject was given others claim better separation when renography is 10 drops of concentrated potassium iodide to mini performed after an overnight fast (3—6). The present mize the uptake of 1311by the thyroid gland. work was done in an attempt to solve this problem and to find out whether there are any interrelation RESULTS ships between the states of hydration and variations Under normal fluid balance, the 10 normal mdi in the renal blood flow on the renogram contour. viduals studied had renal blood flows that ranged from 990 to 1,250 ml/min, or 915 to 1,299 ml! MATERIALS AND METHODS min/ 1.73 m2 surface area, the average being 1,097 This study was performed on 15 normal males ± 127 ml/min/1.73 m2 (mean ±1 s.d.). With aged 19—35years. They were divided into two un hydration, the renal blood flow did not change sig equal groups of 10 and five subjects, respectively. In nificantly in seven cases, the effect being a change of each case the renal blood flow was estimated twice by less than S% from the previous estimation. In the external monitoring of radiohippuran disappearance remaining three subjects the renal blood flow in from the circulation using a collimated scintillation creased in two and decreased in one individual detector placed over the manubrium sterni at the (Table 1) . The mean value for the renal blood flow level of the second ribs (7,8). after overhydration amounted to 1,l0l ± 195 ml! In the group comprising 10 normals, the first min/l.73 m2. measurement was carried out with the subject under The effect of water diuresis on the renal blood normal fluid balance. In the second determination flow after an overnight fast was not different. Out the test was repeated after the patient had drunk of the five normalsstudied,three did not showany 600—1,000 ml of water over a period of 1 hr. This significant change, one had a minor increase and process resulted in diuresis with a urine flow ranging one had slightly decreased renal blood flow (Ta from 2.9 to 21.0 ml/min. ble 2). The effects of hydration on both the radiohippuran Furthermore, there was no noticeable relationship renogram and renal blood flow were studied in the between the rate of urine flow and the type or mag second group of five normal subjects. The test was nitude of response of the renal blood flow to the performed in the sitting position, using a pair of water load used (Tables 1 and 2). well-matched scintillation detectors centered over both kidneys; the sites of the kidneys were deter mined with a small dose of 197Hg. A third detector Received Aug. 16, 1968; revision accepted May 1, 1969. For reprints contact: William J. Maclntyre, University was placed over the manubrium sterni for the simul Hospitals of Cleveland, University Circle, Cleveland, Ohio taneous determination of the renal blood flow. The 44106. collimators used had straight bores with 1½-in.-wide *OnleavefromtheDepartmento@MedicineandDivi sion of Nuclear Medicine, Faculty of Medicine, Cairo Uni apertures; the crystal was recessed 3 in. from the versity, Cairo, U.A.R. 672 JOURNAL OF NUCLEAR MEDICINE TABLE 1. EFFECTOF WATER DIURESISON RENAL BLOOD ROW Renal blood flow Normal fluid Rateof urine flow Age Surfacearea balance Hydrated Change after water load Number (yr) (me) (mI/mm) (mI/mm) (%) (mI/mm) 32 1.65 1,235 1,208 —2.2 20.0 2 26 2.03 1,162 1,282 +10.3 11.6 3 25 1.52 990 951 —3.9 2.5 4 30 1.86 1,030 1,048 +1j 9.5 5 30 2.08 1,100 1,060 —3.6 13J 6 27 1.83 1,076 1,040 —3.3 6J 7 28 1.93 1,160 1,115 —3.9 15.0 8 33 1.68 1,250 1,510 +20.8 21.0 9 32 1.88 1,230 1,280 +4.1 15.6 10 29 1.58 1,035 910 —12.0 4J Mean 29.2 1.80 1,127 1,140 6.6 12.0 ±1s.d. 2J 0.18 94 181 6.1 6.2 TABLE2. RAD1OHIPPURANRENOGRAMOF NORMALSUBJECTSBEFOREAND AFTERHYDRATION for initial rise time between (mm)Pcak (mm)Ratio left and rightRenal of blood of ascendingNo.State ofTime flowSlope flowRate urine hydrationLeft RightLeftRightPeak value limb(mI/mm)(mI/mm) Fasting 0j0 075 6.00 5.00 1.65:1 38:62 1,450 0.5 Hydrated 0.85 0.95 3.50 3.00 1.20:1 41:59 1,148 2.9 2 Fasting 0.95 075 4.50 4.50 0.75:1 47:53 1,356 1.4 Hydrated 0.85 0.80 275 2.75 0.97:1 31 69 1,369 10.3 3 Fasting 070 0.80 3.50 4.50 1.54:1 35:65 730 0.5 Hydrated 075 0.85 3.00 3.25 1.03:1 39:61 712 7.9 4 Fasting 0.85 0.80 6.00 5j5 0.65:1 52:48 1,038 0.2 Hydrated 075 070 2.75 275 0.82:1 57:43 1,041 3.2 5 Fasting 0.65 075 3.00 3.50 0.87:1 45:55 890 1.1 Hydrated 0.80 0.80 3.25 3.00 1.06:1 43:57 1,005 2.6 The radiohippuran renogram is usually described and freer from the stepwise descent that is some by an initial abrupt rise in radioactivity (initial rise times encountered in subjects examined after an or initial deflection), followed by a slower increase overnight fast (Fig. 2) . However, the final portion to reach a peak (ascending limb) and ending with of this limb becameflatter after hydration(Fig. 2). decreasing radioactivity (descending limb or excre tory phase). DISCUSSION Hydration had no constant effect on the time re The results of the present study indicate that there quired for occurrence of the initial rise as can be is no consistent significant change in the total renal seen from the results obtained in the five normals blood flow with hydration. This confirms the results studied (Table 2) . However, with hydration the of previous workers in this field using other tech point of intersection of the ascending limb with the niques to measure the renal blood flow in human initial deflection was identifiable even in the cases beings (9—11). Therefore any alteration in the shape in which it was not distinctin the hydropenicstate of the radioisotope renogram under the effect of due to the multiphasic character of the ascending water load cannot be explained by a concomitant limb (Fig. 1). The slope of the ascending limb be change in the total renal blood flow. However, this came steeper, reaching peak value in a shorter time does not exclude the possibility of an intrarenal re interval (Table 2). In addition, the ratio between distribution of blood flow as suggested by Thurau the peak counting rates attained by both kidneys ap et al (12) . This group of workers showed that with proached unity (Table 2 and Fig. 2) . Regarding water diuresis the glomerular filtration rate, total the descending limb, with hydration it became steeper renal blood flow and mean transittime throughthe Volume 10, Number 11 673 RAZZAK, BOTTI AND MAC INTYRE cortex did not change. But there was a definite renogram became steeper and radioactivity reached decrease in the transit time through the medulla, peak value earlier. These findings were also reported suggestingan increasein the medullaryblood flow. by previous workers (6,13) who explained them as In the present work it was observed that with being due to more rapid transit of radioactivity hydration the slope of the ascending limb of the through the kidneys. In view of the change observed RADIOHIPPURAN RENOGRAM in the actual slope of this segment (Figs. 1 and 2) URINE FLOWRATE as well as the variation in ratio between the slopes .4 m/min. of both sides after hydration (Table 2) without con stant change in the renal blood flow, the slope of the U) ascending limb as such cannot readily be used for z calculation of the relative renal blood flow to each 0 0 w kidney. This has been suggested by previous workers U) (4,5), but would not be considered valid until it is shown that even in normal subjects the relative Ui a. blood flow to each kidney varies with the degree of U,I- hydration of the person examined. Moreover, using zD 0 0 this method of calculation as suggested by the work ers mentioned above, the relative blood flow to one kidney was 1½times or more than that going to the other kidney in five out of the 10 examples calcu lated and cited in Table 2.
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