Society of Nuclear Medicine India Guidelines for Procedure and Reporting of Diuretic Renal Scintigraphy in Adult and Paediatric Patients with Suspected Upper Urinary Tract Obstruction

Diuretic renal scintigraphy (DRS) is the established non-invasive nuclear medicine technique for simultaneously assessing differential renal function (DRF) and upper urinary tract drainage dynamics in patients with suspected obstruction to urinary flow. This Society of Nuclear Medicine India (SNMI) guidelines document aims to provide comprehensive, evidence-based recommendations for the standardised performance, processing, interpretation, and reporting of DRS in both adult and paediatric patients with dilated upper urinary tract, with due consideration of the Indian context. The guidelines address patient preparation, hydration protocols, bladder management, radiopharmaceutical selection (tubular agents such as Tc-99m L,L EC and Tc-99m MAG3 are preferred), furosemide dosing and timing protocols (F−15, F=0, F+20), acquisition parameters, interpretation parameters including semiquantitative metrics such as T½, normalised residual activity (NORA), and DRF, as well as structured reporting and interpretation criteria. Due emphasis is placed on technical quality assurance, recognition of indeterminate and non-diagnostic studies, radiation safety and as low as reasonably achievable (ALARA) principles, and infrastructure requirements applicable to Indian nuclear medicine centres. The limitations inherent to the technique are discussed, and a note is made on future directions (e.g., artificial intelligence-assisted analysis and positron emission tomography (PET) based renography). These guidelines are intended to support nuclear medicine physicians in delivering consistent, high-quality DRS studies that guide timely clinical decision-making and preserve long-term renal function.