Captopril

2. CAPTOPRIL RENOGRAPHY IN
THE EVALUATION OF
HYPERTENSIVE PATIENTS
DR. V. SIVA SUBRAMANIYAN,
DEPT. OF NUCLEAR MEDICINE,
SSSIHMS, PRASHANTHIGRAM.

3. A I M S
¨I N C I D E N C E O F R.A.S
¨U T I L I T Y OF CAPTOPRIL
¨E F F E C T O F C A P T O P R I L O N
¨H Y P E R T E N S I V E S

4. PATHOPHYSIOLOGY OF R.V.H

5. I N D I C A T I O N S

6.  Accidental invention.
 Majid et al 1983
 Marked decreased renal uptake in
a patient taking Captopril.
 On discontinuation recovery of
renal function.
D I S C O V E R Y

7. M E T H O D O L O GY
¨BETA – BLOCKERS AND
ANTIHYPERTENSIVES TO BE
STOPPED 48 – 72 HRS. BEFORE
THE STUDY

BASAL RENOGRAPHY TO BE
PERFORMED.

CLASSICAL CONVENTIONAL
PROCEDURE TO BE FOLLOWED.

8. Tracer 99 Tc m – DTPA.
Dose : 3-5 mCi
 Route : IV injection
 Preparation : Proper hydration.
R E N A L S C I N T I G R A P H Y

9. M E T H O D O L O G Y
25 – 50 mg CAPTOPRIL TABLETS TO
BE CRUSHED AND ADMINISTERED
ORALLY ALONG WITH 250 ml OF
WATER. 90min. LATER RENAL
SCINTIGRAPHY IS REPEATED WITH
TWICE THE DOSE OF TC 99 m DTPA
USED FOR BASE LINE.

10. I N T E R P R E T A T I O N
 Image analysis
 GFR estimation.
 Renographic curve analysis
 Captopril response

11. P O S I T I V E C R I T E R I A
 Decrease in % of uptake by > 10%.
 Reduction in GFR by > 10%
 Worsening of renographic curves
 Increased tracer retention
 Increased transit time

12. R E N O G R A M T Y P E S

13. CAPTOPRIL RESPONSE

18. SSSIHMS
PRASHANTIGRAM__________________________________________________________________

Name: Sudha Sree Purna. A Age / Sex: 37/F Hospital No: 53773/k2
Procedure: Captopril Renography Date: 19/08/02 N.M N0. RD /4658&63/2002
Tracer: Tc-99m DTPA Dose: 10 Mci Route: Intravenous
Protocol: Gates Diuretic: Lasix 40 mg i.v Time: F 0
Hydration: plenty of oral fluid

Clinical History: ? Renovasular Hypertension. Right Kidney small on Ultra Sound Scan.
Renal Scan for functional assessment of the Kidneys.
Procedure: After obtaining the Basal study Anti-hypertensives stopped for 2 days. Captopril
50 mg administered orally and after 3 hours Renogram study is repeated.

IMAGES



INTERPRETATION

K I D N E Y S C O R T E X
Site Size Position Visualization Delineation Defect Contour
RT. Normal Normal Normal Prompt Fair Nil Smooth
LT. Normal Normal Normal Prompt Good Nil Smooth

C O L L E C T I N G S Y S T E M U R E T E R
Visualisn. Delineation Uptake late fill. Visualisn. Accumulation Insertion
RT. Prompt Good Increased Nil Faint Trace Normal
LT. Prompt Good Increased Nil Faint Trace Normal

R E N O G R A P H I C C U R V E A N A L Y S I S
PHASE: Uptake Secretory Excretory Diur.response G.F.R % Function
Pre Post Pre Post Pre Post Pre Post Pre Post Pre Post
RT. Vertical Verti Blunted Blunt. Step PlateauType I TypeIII 36 ml 32 ml 46 % 43 %
LT. Vertical Verti Slope Slope Step Step Type I Type I 42 ml 43 ml 54 % 57 %

TOTAL GFR Pre 78 Post 75 ml / min
IMPRESSION:
The Post Captopril Study reveals evidence of Decrease in the Rt. Kidney GFR with
worsening of Curve pattern indicating the High Probabiliy of Rt. Renal Artery Stenosis.

DR.V.SIVASUBRAMANIYAN ,
Consultant Nuclear Medicine Physician
___________________________________________________________________________________

21. CAPTOPRIL SERIES
Male : 16-68 yrs ; 36.4 +- 13.6 51
Female : 15-50 yrs ; 34.5 +- 8.9 17
Total 68

22. R E S U L T S
Positive: 11 / 6816%
Negative : 57 / 6884%

23. N E G A T I V E G R O U P
82 +- 30 ml/
min
75 +- 29 ml/
min
Post-capto
66 +- 28 ml/
min
61 +- 25 ml/
min
Pre-capto
FemalesMales

24. C O N T R A I N D I C A T I O N S
¨B I L A T E R A L R.A.S
¨DRUG STOPPAGE NOT POSSIBLE
¨IMPENDING RENAL FAILURE

25.  Recent invention by
Imanishi et al. 1991
 Substitute to Captopril.
A S P R I N R E N O G R A P H Y

26. P R O C E D U R E
 Asprin - 20 mg / kg130 mg
 Oral administration
 Renal scintigraphy one hour later.

27. P A T H O P H Y S I O L O G Y
Prostaglandin
Vasodilatation
Increases glomerular blood flow
Asprin blocks prostaglandin
Decrease in glomerular blood flow.

28. A D V A N T A G E S
 No stopping of ACEI / Beta blockers.
 No threat of HYPOTENSION.
 No hazard of renal shutdown.

29. DISADVANTAGES
 Positive in 57 % only.
 Sub-groups specificity.
 Selective insensitivity.

30. F L O W C H A R T
High risk hypertensive
Color duplex doppler sonography
Renal artery stenosis
Positive Equivocal Negative
Drug stoppage
Possible Not possible
PTRA Captopril Asprin Exr. renogram

31. C O N C L U S I O N
Difficult situations.
Definitive role.
Decision making.