From the Guidelines
Technetium pyrophosphate scans do not have a significant adverse effect on kidney function, as the radiotracer is primarily cleared through the urinary system with minimal nephrotoxicity at standard diagnostic doses. The evidence from the 2022 AHA/ACC/HFSA guideline for the management of heart failure 1 supports the use of technetium pyrophosphate scans for the diagnosis of ATTR-CM, without mentioning any significant kidney-related adverse effects.
Key Points to Consider
- The radiotracer used in these scans, technetium-99m pyrophosphate, is primarily cleared through the urinary system but has minimal nephrotoxicity at standard diagnostic doses.
- Unlike iodinated contrast agents used in CT scans or gadolinium-based contrast agents used in MRI, technetium-99m pyrophosphate does not carry significant risk of contrast-induced nephropathy or nephrogenic systemic fibrosis.
- Proper hydration before and after the procedure is still recommended to facilitate radiotracer clearance.
- In patients with severe renal impairment, the radiologist or nuclear medicine physician may consider dose adjustments, but complete avoidance is rarely necessary.
Clinical Implications
The benefit of diagnostic information from technetium pyrophosphate scans, particularly in cases of suspected cardiac amyloidosis or myocardial infarction, typically outweighs any theoretical risk to kidney function 1. Therefore, technetium pyrophosphate scans can be safely used in patients with normal kidney function, and in those with impaired kidney function, the benefits of the scan should be weighed against the potential risks.
From the Research
Effect of Technetium Pyrophosphate Scans on Kidneys
- The studies provided do not directly address the effect of Technetium pyrophosphate scans on kidneys, but rather their use in diagnosing and managing various kidney-related conditions 2, 3, 4.
- One study suggests that Technetium-99m-pyrophosphate imaging may be useful in identifying the cause of acute renal failure in patients with suspected rhabdomyolysis 2.
- Another study found that Technetium-99m-dimercaptosuccinic acid uptake, not Technetium pyrophosphate, correlates well with renal function measured by creatinine clearance and serum creatinine 5.
- A study on the diagnosis of renal osteodystrophy using Technetium-99m-pyrophosphate bone scintigraphy found that the scans did not provide therapeutically useful information that could not be obtained from biochemical and radiological studies 3.
- A more recent study assessed the safety and accuracy of renal static scintigraphy using Technetium-99m and found that introduction of a correcting factor for Technetium-99m decay improved the accuracy of kidney function evaluation 6.
- An older study reported a high incidence of abnormal 99mTechnetium-tin-pyrophosphate bone scans in chronic renal failure patients, suggesting that the scans may be useful in the diagnosis and management of renal osteodystrophy 4.