Increased Patchy Renal Accumulation of ^99mTc-Methylene Diphosphonate in a Patient with Severe Loin Pain after Exercise

Abstract

RadionucHde imaging in a patient who had acute renal failure with severe loin pain and patchy renal vasoconstriction is described. The patient was studied 3 h after the intravenous bolus injection of 25 mCi ^99mTc-methylene diphosphonate (^99mTc-MDP). An intense patchy renal concentration of ^99mTc-MDP was observed.

Bone Scintigraphy in Acute Renal Failure with Severe Loin Pain and Patchy Renal Vasoconstriction

“…Focal increased accumulation of the kidney has been reported in urinary tract obstruction, metastatic calcification and radiation [20], but the findings are quite different from those of patchy vasoconstriction. In 5 of our patients and 1 of Ishikawa et al [6] patchy areas of increased accumulation of the kidney were observed. These findings suggest that patchy ischemic damage of the kidney results in the functional derangement of the cell membrane and intracellular flux of calcium ions, and an increase in intracellular calcium in ischemic tissue may cause the focal accumulation in bone-seeking radi oisotopes [8,21], We think that 4 h after radioactive isotope injection is the best timing to perform the bone scintigraphy.…”

“…ARF with severe loin pain and evidence of patchy renal vasoconstriction such as wedge-shaped contrast enhancement on the renal CT occurs in young and previ ously healthy persons and has been known by the 7 cases reported by Ishikawa et al [4][5][6][7], Of the 7 cases, 4 had histories of both analgesics and exercise, such as track race, swimming, skiing and weight lifting, 2 had taken Urine myoglobin ------BUN = Blood urea nitrogen; HPF= high-power field; ND = not done. Diffusely enhanced = Diffuse enhancement without focal lesion in the kidney; patchy low density = patchy areas of less enhancement; patchy wedge = patchy wedge-shaped areas of radiocontrast enhancement; disappeared = disappearance of wedge-shaped areas of radiocontrast enhancement; ND = not done.…”

“…The wedge-shaped lesions suggest that vasocon striction on the level of interlobar or arcuate arteries in the kidney results in patchy areas of ischemic damage [16,18]. So the characteristic wedge-shaped enhancement on the CT is an important diagnostic clue of this disease entity [5,6], along with the history of clinical findings, such as exercise and severe loin pain.…”

“…Since the first report by Ishikawa et al [4] of ARF with severe back pain and patchy enhancement on postcontrast renal computed tomography (CT) after the intake of analgesics without obvious evidence of myoglobinuria, there have been 6 additional cases of ARF with severe loin pain after exer cise or analgesics and characteristic findings of patchy wedge-shaped contrast enhancement of the kidney on the CT [5][6][7], These cases of ARF have been regarded as an entity of ARF due to patchy renal vasoconstriction, and the typical patchy wedge-shaped contrast enhancement of the kidney is to be one of the essential diagnostic features.…”

Acute Tubular Necrosis with Loin Pain and Persistent Multiple Wedge-Shaped Contrast Enhancement on CT.

“…In an experimental model using the 133Xe wash-out, Hollenberg et al suspected patchy vasoconstriction in the recovery phase of acute tubular necrosis (12). Radionuclide imaging (Ci "m Tc-methylene diphosphonate) (13), magnetic resonance imaging (MRI) (14) and renal sonography ( 15) have been reported to be useful in the diagnostic procedure without a contrast medium.However,in the present case, MRI, radio imaging and renal sonography were not effective for the differential diagnosis between renal ischemia and renal infarction. Enhanced CTscan maybe the most useful for the diagnosis of acute renal failure and the observation of the recovery phase.…”