**Northern Lincolnshire and Goole NHS Foundation Trust - Nuclear Medicine** 

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^  Authorised By  ^  Authorising Role  ^  Authorisation Signature \\  (only on master paper copy)  ^  Date Authorised  |
|  Dr Avery  |  ARSAC Licence Holder  |    |  2025-01-14  |

====== REF013 - Diuretic Renogram ======
See [[referral_criteria:ref000-how_to_refer_to_nlagnm|REF000 - Referring to Nuclear Medicine (NLAG)]] for details on how to refer. 

=====  Description =====
A renogram involves the intravenous administration of a radioactive tracer (usually Tc99m-MAG3) which is cleared from the blood by the kidneys. Dynamic images of the kidneys are acquired as the tracer is injected and over a period of 30-40 minutes to monitor the passage of the tracer through the kidneys and into the bladder. It is used to assess renal function and urine transit and can identify obstruction. Furosemide is usually administered to increase the diuresis rate. Once the tracer has reached the bladder, further dynamic imaging can be obtained to assess for the presence of reflux whilst the patient empties their bladder.

Renograms are routinely performed on adults and children. Younger children may need sedation.


[[sqlite:unused:unused:unused:/home/heynmorg/public_html/wikifarm/nlag/data/meta/arsac/database2019.db|SELECT fullname AS "ARSAC Licence Holders" 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-113-113'  AND date('now')<=expirydate  ORDER BY expirydate|0]]


^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).
  * Furosemide (usually 40mg in adults). In patients with very poor renal function please indicate on the request the dose of Furosemide required to achieve diuresis. 

===== Contraindications =====
  * Pregnancy
  * Furosemide is contraindicated in patients suffering from renal failure with anuria.

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

|Measure the relative function of a possibly obstructed kidney in order to determine whether renal function is compromised and establish a baseline for monitoring any future loss of function that might require intervention [([[https://doi.org/10.1053/j.semnuclmed.2018.02.010|SNMMIProcedure Standard/EANM Practice Guideline for Diuretic Renal Scintigraphy in Adults With Suspected Upper Urinary Tract Obstruction 1.0.]])]  |
|Determine whether renal obstruction is present in a patient who has signs or symptoms of obstruction [(#1)]  |
|Determine whether renal obstruction is present in an asymptomatic patient for whom hydronephrosis was detected on prior imaging [(#1)]  |
|Post surgical evaluation of a previously obstructed system [([[https://cdn.ymaws.com/www.bnms.org.uk/resource/resmgr/guidelines/dynamic_renal_radionuclide_s.pdf|Dynamic Renal Radionuclide Studies (Renography) BNMS Clinical Guidelines August 2011]])]  | 
|Assessment of a dilated collecting system as a cause of back pain  |
|Assessment of renal transplants [(#2)][([[https://doi.org/10.1016/S0001-2998(05)80006-6|Dubovsky et al. Radionuclide evaluation of renal transplants. Seminars in Nuclear Medicine. Volume 25, Issue 1, January 1995, Pages 49-59]])]  |
|Assessment of hydronephrosis  |
|Assessment of vesico-ureteric reflux [(#2)][([[https://www.acr.org/-/media/ACR/Files/Practice-Parameters/RadionuclideCystog.pdf|ACR–ACNM–SNMMI–SPR PRACTICE PARAMETER FOR THE PERFORMANCE OF RADIONUCLIDE CYSTOGRAPHY (revised 2020) ]])]   |