Individual renal plasma flow determination without ureteral catheterization

Quantitative assessment of the determinant structural differences between redox-active and inactive glutaredoxins

Class I glutaredoxins are enzymatically active, glutathione-dependent oxidoreductases, whilst class II glutaredoxins are typically enzymatically inactive, Fe-S cluster-binding proteins. Enzymatically active glutaredoxins harbor both a glutathione-scaffold site for reacting with glutathionylated disulfide substrates and a glutathione-activator site for reacting with reduced glutathione. Here, using yeast ScGrx7 as a model protein, we comprehensively identified and characterized key residues from four distinct protein regions, as well as the covalently bound glutathione moiety, and quantified their contribution to both interaction sites. Additionally, we developed a redox-sensitive GFP2-based assay, which allowed the real-time assessment of glutaredoxin structure-function relationships inside living cells. Finally, we employed this assay to rapidly screen multiple glutaredoxin mutants, ultimately enabling us to convert enzymatically active and inactive glutaredoxins into each other. In summary, we have gained a comprehensive understanding of the mechanistic underpinnings of glutaredoxin catalysis and have elucidated the determinant structural differences between the two main classes of glutaredoxins.

Glutaredoxins play a central role in numerous biological processes including cellular redox homeostasis and Fe-S cluster biogenesis. Here the authors establish the molecular basis for glutaredoxin redox catalysis through comprehensive biochemical and structural analyses.

Renal radiopharmaceuticals--an update

Noninvasive radionuclide procedures in the evaluation of renal disease have been accepted increasingly as effective and valuable alternatives to older clinical methods. The development of suitable radiopharmaceuticals labeled with high photon intensity radionuclides and with 99mTc in particular has stimulated this modality during the last few years. Currently several nearly ideal agents are available for anatomical and functional studies of kidney imparting very low absorbed radiation doses. These include 99mTc-GHA and 99mTc-DMSA for renal morphology and differential function evaluation, 99mTc-DTPA for GFR and 123I orthoiodohippurate for ERPF measurements. A suitable agent as a replacement for the latter labeled with 99mTc is actively being sought. Computer-assisted processing of dynamic renal function studies enables the observer to obtain a wealth of information related to the renal extraction, uptake, parenchymal transit and pelvic transit parameters of the agent administered into the bloodstream. Each of these parameters either globally or differentially contributes to a detailed evaluation of renal disease states. Several of these procedures have been validated against classical techniques clinically but more detailed information is being sought with the recently introduced radiopharmaceuticals. With the detailed validation and increasing recognition of the clinical utility of several of the radionuclidic procedures at many centers, it is hoped that radionuclide assessment of renal disorders ultimately will be made available routinely at all medical facilities.

A simple method for measuring separate glomerular filtration rate using a single injection of 99mTc-DTPA and the scintillation camera

A new technique for measuring glomerular filtration in each kidney has been developed using a scintillation camera and the 99mTc-DTPA complex. The technique has been applied to 101 children with various uropathies. Correlations with the total and separate creatinine clearance, the HgCl2 uptake test, and the maximal urinary concentration have been good. The reproducibility of the method has been satisfactory in a small number of patients. The test is particularly adapted to children because of its simplicity, reduced trauma, short duration (20 minutes) and low-radiation dose. In contrast to some other radioisotope techniques, it can be carried out in infants.

99mTechnetium penicillamine scans: an index of differential renal function

The relative renal accumulation of 99mtechnetium penicillamine was evaluated as an index of differential renal function. Regions of interest were assigned over each kidney with a computer and the renal uptake of 99mtechnetium penicillamine was determined. A simple background correction was made by subtracting the renal activity at 10 minutes from that at 25 minutes. The percentage of 99mtechnetium penicillamine accumulation in the left kidney was correlated with the percentage of the total effective renal plasma flow to the left kidney. Effective renal plasma flow was determined after the intravenous injection of 131 I hippuran using a highly sophisticated computerized technique that has been validated in patients by comparison with traditional split renal function studies. The correlation coefficient between the 2 measurements was 0.97. In addition to its use as an index of differential effective renal plasma flow 99mtechnetium penicillamine is an excellent cortical imaging agent and the relative distribution of 99mtechnetium penicillamine between the 2 kidneys and within a single kidney can be assessed qualitatively by visual inspection of the scan.

Validity of 99mTc dimercaptosuccinic acid renal uptake for an assessment for individual kidney function

99mTc dimercaptosuccinic acid is a new renal scanning agent that provides a good quality of renal image as a result of preferential cortical accumulation and also makes feasible a quantitative assessment of separate kidney function, correlating well with renal plasma flow obtained from a 131I hippuran renogram of each kidney. By measuring the dimercaptosuccinic acid uptake, the cortical functioning nephrons can be determined independent of the activity from the urinary outflow tract. Such evaluations may replace the conventional split renal function study in which traumatic procedures, such as cystoscopy and ureteral catheterizations, are required. 99mTc dimercaptosuccinic acid scintigraphy causes less discomfort to the patient and can be performed repeatedly and routinely even in children and debilitated geriatric patients.

Estimating relative renal function

Radionuclide measurements of relative renal function have been made using conventional dual-probe renography, computer assisted triple-probe renography, rectilinear kidney scanning and computer assisted gamma camera renography and kidney scanning. The relative area of each kidney from the excretory urogram also has been used to measure relative function. The best correlation between renography and kidney scanning was obtained with the gamma camera computer system. The relative function of each kidney was obtained by outlining regions of interest that corresponded closely to the renal images and subtracting the blood and tissue background activity, using a special background region. Triple-probe renography, using computer assisted blood background subtraction, provides another reliable indicator of relative function, which is considerably more accurate than conventional dual-probe renography. Relative renal function also may be determined, but with less precision, from the relative counts in a rectilinear kidney scan, from the relative scan areas and from the relative areas found on excretory urography. Both relative area methods are less reliable in the presence of outflow tract obstruction, renal tumors and renal cysts.

Renal scintiscanning. A review

Renal scintiscanning is a simple investigation that does not require special preparation and is well tolerated by patients.

Radiopharmaceuticals used in linear scanning are accumulated in the renal cortex. This accumulation is diminished: (a) when the cortex is destroyed, e.g. by pyelonephritis, injury, etc.; and (b) when the amount available to the cortex is reduced, e.g. by ischaemia. The scintigram depicts the kidneys unimpeded by bowel contents, gives a qualitative assessment of renal function and shows the distribution of zones of normal function. Recent technical improvements show great promise in deriving a quantitative measure of renal function in some circumstances.

The location of normally functioning cortex is often important in the management of renal diseases and the value of scintiscanning is then considerable. It is occasionally useful in planning surgery.

The anatomy of the renal collecting system can be shown only by urography. High dose techniques achieve this even in the face of renal failure, and scintiscanning has few indications in investigating lesions that distort the renal anatomy, e.g. tumours and cysts.

Renal scintiscanning is a very valuable additional method to urography, arteriography and renography in investigation of renal disorders.