**Hull University Teaching Hospitals NHS Trust - Nuclear Medicine** 


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[[sqlite:unused:unused:unused:/home/heynmorg/public_html/wiki/data/meta/examcodes/database.db|SELECT sop AS "SOP Code",title AS "Title",reviewdate AS "Review Date" FROM sops WHERE sop='REF004'|0]] 
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|   Dr N Ahmed            | ARSAC Licence Holder     |                                                           |   2024-06-17         |

====== REF004 - DMSA Renal Imaging Referral Criteria ======
See [[referral_criteria:ref000-how_to_refer_to_huthnm|REF000 - Referring to Nuclear Medicine (HUTH)]] for details of how to refer.  
===== Description =====
Following intravenous injection, Tc99m-DMSA accumulates in the proximal renal tubules with very little washout. Static images of the kidneys can be obtained providing definition of the cortical outline and relative distribution of functional tissue. It can identify areas of cortical scarring.  The ratio of radiopharmaceutical uptake between the kidneys provides a measure of divided renal function. By selecting regions of interest within an individual kidney, it is also possible to measure the relative function at these sites, which may be of relevance when a duplex system is present.

[[sqlite:unused:unused:unused:/home/heynmorg/public_html/wiki/data/meta/arsac/database2019.db|SELECT fullname AS "ARSAC Licence Holders", investigation AS "Indication" FROM practitionerlicences INNER JOIN practitioners,procedurecodes,praclicproc,nuclides,chemicalforms ON practitionerlicences.practitioner=practitioners.id AND praclicproc.plicid=practitionerlicences.id AND praclicproc.procid=procedurecodes.id AND procedurecodes.nuclide_id=nuclides.id AND procedurecodes.chemicalform_id=chemicalforms.id AND practitionerlicences.certificateactive='Y' WHERE procedure_code='99mTc-33-112'  AND date('now')<=expirydate  ORDER BY expirydate|0]]

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^                              ^ Radiopharmaceutical  ^
^Typical Radiation Dose (mSv)  |  0.7    |     

===== Staff Entitled to Refer =====
All UK registered medical practitioners

===== Supplementary Drugs =====
Sodium chloride for parenteral use (0.9% w/v).

===== Contraindications =====
Pregnancy

A pre-existing urinary tract infection, or infection within the last 4 months may give false results.

===== Clinical Indications =====

|Renal parenchymal scarring (at least 4-6 months following an acute UTI) [([[https://link.springer.com/article/10.1007/s00259-018-4129-6|Blaufox, M.D., De Palma, D., Taylor, A. et al. The SNMMI and EANM practice guideline for renal scintigraphy in adults. Eur J Nucl Med Mol Imaging 45, 2218–2228 (2018)]])][([[https://link.springer.com/article/10.1007/s40336-022-00484-x|Vali, R., Armstrong, I.S., Bar-Sever, Z. et al. SNMMI procedure standard/EANM practice guideline on pediatric [99mTc]Tc-DMSA renal cortical scintigraphy: an update. Clin Transl Imaging 10, 173–184 (2022)]])][([[https://www.nice.org.uk/guidance/ng224|NICE guideline [NG224].Urinary tract infection in under 16s: diagnosis and management. Published: 27 July 2022]])]   |
|Acute and chronic renal failure[(#1)]  |
|Pyelonephritis[(#1)][(#2)]  |
|Unilateral/bilateral renal disease (space-occupying lesions included) [(#1)]  |
|Detection of parenchymal damage after trauma [(#2)]  |
|Characterization of structural renal abnormalities: e.g. solitary kidney, duplex kidney, small kidney, dysplastic kidney, horseshoe kidney, and pseudo-horseshoe kidney[(#2)]  |
|Detection of ectopic renal tissue, including cross-fused renal ectopia[(#2)]  |
|Differential renal function[(#2)]  |
|Confirmation of non-functional multicystic dysplastic kidney[(#2)]  |
|Evaluation of unexplained hypertension when there is clinical suspicion for renal disease such as dysplasia or scarring[(#2)]  |
|Evaluation of renal parenchymal function in patients with renovascular hypertension before and after revascularisation procedures[(#2)]  |
|Renal parenchymal function regional assessment in patients with complex renal calculi before and after treatment[(#2)]  |
|Surgical decision-making for ureteropelvic junction obstruction (UPJO) or refractory VUR based on differential renal function [(#2)]  |
|Pre-transplant donor assessment  |