DMSA Case 3 Answers

1) Explain the unusual appearances

The patient is in advanced renal failure with a serum creatinine of 500. The concentration of tracer in the kidneys is poor and background uptake is high and tracer is seen within the lungs and liver.

Normally only 3% of the DMSA should be seen in the liver at 3-4hours - i.e. very small amounts. When renal uptake of DMSA is very low, the liver may accumulate DMSA as an alternative excretory pathway.

DMSA renal uptake is highly pH-dependent and any cause of acidosis (such as renal tubular acidosis) can cause a lack of renal uptake. Click here for similar case, where the patient had mild renal impairment (Cr=180) but was acidotic due sepsis.

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