Question:
A patient presents with acute renal failure and anuria. The ultrasound is normal. Which of the following investigations will give the best information regarding renal function?
A patient presents with acute renal failure and anuria. The ultrasound is normal. Which of the following investigations will give the best information regarding renal function?
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You need function, not anatomy, and a glomerular-filtered tracer fits even in renal failure.
Updated On: Jun 24, 2026
- Intravenous pyelogram
- Retrograde pyelography
- Antegrade pyelography
- DTPA scan
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The Correct Option is D
Solution and Explanation
Step 1: The patient has acute renal failure with anuria and a normal ultrasound, which rules out obstruction. The clinical need is a test of function, not anatomy.
Step 2: A radionuclide DTPA (technetium-99m diethylenetriaminepentaacetic acid) scan is filtered freely by the glomerulus and is not secreted or reabsorbed. This lets it measure the glomerular filtration rate and show split function and perfusion of each kidney, all without needing good renal function to excrete iodinated contrast.
Step 3: Why the others are wrong. An intravenous pyelogram relies on the kidneys concentrating and excreting iodinated contrast; in renal failure the contrast is poorly excreted, so images are poor and the contrast itself is nephrotoxic. Retrograde and antegrade pyelography are anatomical studies of the collecting system used to assess obstruction, not function, and they are invasive.
Step 4: Since ultrasound has already excluded obstruction and we want functional information, the DTPA scan is the best choice.
Step 5: Answer: Option D, DTPA scan.
Step 2: A radionuclide DTPA (technetium-99m diethylenetriaminepentaacetic acid) scan is filtered freely by the glomerulus and is not secreted or reabsorbed. This lets it measure the glomerular filtration rate and show split function and perfusion of each kidney, all without needing good renal function to excrete iodinated contrast.
Step 3: Why the others are wrong. An intravenous pyelogram relies on the kidneys concentrating and excreting iodinated contrast; in renal failure the contrast is poorly excreted, so images are poor and the contrast itself is nephrotoxic. Retrograde and antegrade pyelography are anatomical studies of the collecting system used to assess obstruction, not function, and they are invasive.
Step 4: Since ultrasound has already excluded obstruction and we want functional information, the DTPA scan is the best choice.
Step 5: Answer: Option D, DTPA scan.
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