The use of gallium-67 scintigraphy in the diagnosis of acute interstitial nephritis

Graham, François; Lord, Martin; Froment, Daniel; Cardinal, Héloïse; Bollée, Guillaume

doi:10.1093/ckj/sfv129

Cited by 28 publications

(24 citation statements)

References 15 publications

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“…10 As shown in Figure 1A, gallium-67 scintigraphy was useful in the diagnosis of AIN. 11 In addition, urinary β 2 -microglobulin and NAG are reported to be useful markers of renal interstitial damage. These markers and Scr levels were remitted with the discontinuation of alogliptin treatment alone.…”

Section: Discussionmentioning

confidence: 99%

Alogliptin-Induced Minimal Change Nephrotic Syndrome and Interstitial Nephritis

Shima¹,

Okamoto²,

Tashiro³

et al. 2019

Kidney Medicine

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Alogliptin is one of the dipeptidyl peptidase-4 inhibitors used to treat patients with type 2 diabetes. Little is known about the nephrotoxicity associated with alogliptin, such as nephrotic syndrome or interstitial nephritis. We report a biopsy-proven rare case of minimal change nephrotic syndrome and interstitial nephritis induced by alogliptin. A 68-year-old man who had been prescribed alogliptin was hospitalized for nephrotic syndrome. On admission, serum creatinine level was elevated with increased urinary β 2-microglobulin and N-acetyl-β-D-glucosaminidase excretion. Kidney biopsy revealed minor glomerular abnormalities and interstitial nephritis, and gallium-67 scintigraphy showed uptake in both kidneys. A drug lymphocyte stimulation test for alogliptin was positive. With discontinuation of alogliptin treatment alone, serum creatinine level normalized in parallel with urine β 2-microglobulin and N-acetyl-β-D-glucosaminidase levels. In addition, complete remission of nephrotic syndrome was observed. Drug-induced dual pathology has not been previously reported with alogliptin. In summary, clinicians should keep in mind that alogliptin can induce minimal change nephrotic syndrome and interstitial nephritis.

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Section: Discussionmentioning

confidence: 99%

Alogliptin-Induced Minimal Change Nephrotic Syndrome and Interstitial Nephritis

Shima¹,

Okamoto²,

Tashiro³

et al. 2019

Kidney Medicine

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“…Contrasting results were obtained by two other small studies that reported a low sensitivity of Ga-67 scintigraphy in the diagnosis of ATIN [ 18 , 19 ]. Very recently, Graham et al described 76 patients who underwent Ga-67 scintigraphy for suspicion of ATIN [ 12 ]. Intensity of radioisotope uptake in the kidney was graded from 0 to 5 and, when using a cut-off value of 3, the authors obtained a sensitivity of 61% and a specificity of 75% for the diagnosis of ATIN.…”

Section: Discussionmentioning

confidence: 99%

“…Gallium-67 (Ga-67) scintigraphy has been suggested as a useful non-invasive method in patients with a clinical suspicion of ATIN [ 8–11 ]. However, its diagnostic performance and usefulness remain controversial [ 12 ]. Moreover, this exam is aggravated by a significant biological cost due to the high radiation exposure, especially in childhood.…”

Section: Introductionmentioning

confidence: 99%

Usefulness of 99mTc-dimercaptosuccinic acid renal scan in the diagnosis and follow-up of acute tubulointerstitial nephritis in children

Vidal

Miorin

Zucchetta

et al. 2017

Clinical Kidney Journal

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BackgroundSymptoms and signs of acute tubulointerstitial nephritis (ATIN) are nonspecific; therefore, renal biopsy is often necessary to clarify the diagnosis. The aim of this study was to evaluate the use of 99mTc-dimercaptosuccinic acid (DMSA) scintigraphy in the diagnosis and follow-up of ATIN.MethodsWe retrospectively reviewed the charts of five patients (nine renal units) with a median age of 14 years who underwent DMSA scan after a clinical and/or biopsy-proven diagnosis of ATIN. The exam was performed within 1 month after disease onset and repeated at a median time of 12 months after the acute phase.ResultsDMSA renal scans performed during the acute phase allowed the discovery of suggestive findings, including diffuse reduction of the renal uptake of radionuclide and presence of multiple ‘cold’ focal lesions in a corticomedullary distribution. The follow-up scintigraphy resulted normal in two patients who were treated with steroids and in one patient who presented a mild renal dysfunction in the acute phase. By contrast, the control scan showed persistent renal damage in one patient who was further readmitted because of hypertension and in one renal transplanted patient who presented a Stage 3 acute kidney injury in the acute phase.ConclusionsDMSA renal scan might be a reliable tool for an early non-invasive diagnosis of ATIN in children and might be particularly useful in those patients who are not candidates for a kidney biopsy. Moreover, DMSA scan gives accurate follow-up evaluation, as it allows monitoring of the evolution of acute renal parenchymal inflammation with potential risk of renal scar formation. Due to the small sample size, our findings warrant further validation in a larger study.

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“…The patient’s worsening sCr level was thought to be because of ATIN, which is consistent with the increase in urine beta2-microglobulin. Gallium-67 scintigraphy is useful for differentiating ATIN from acute tubular necrosis [ 3 , 14 ]. If a patient has glomerulonephritis, its interpretation is not conclusive but supportive of tubulointerstitial changes in the kidney.…”

Section: Discussionmentioning

confidence: 99%

Cilostazol-induced acute tubulointerstitial nephritis accompanied by IgA nephropathy: a case report

Shima¹,

Tashiro²,

Yamada³

et al. 2018

BMC Nephrol

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BackgroundCilostazol is an antiplatelet drug that is widely prescribed for the prevention of secondary stroke. Adverse reactions to cilostazol include headaches, palpitations, and diarrhea. Little is known about the nephrotoxicity of cilostazol, such as acute kidney injury. We report a biopsy-proven case of diffuse tubulointerstitial nephritis induced by cilostazol.Case presentationA 69-year-old woman prescribed cilostazol was hospitalized for acute kidney injury. On admission, her renal function deteriorated, with an increased serum creatinine level. Urinalysis showed hematuria, proteinuria, and hyper-beta2-microglobulinuria. A renal biopsy revealed diffuse tubulointerstitial nephritis associated with IgA nephropathy, and gallium-67 scintigraphy showed uptake in the bilateral kidneys. A drug lymphocyte stimulation test for cilostazol was positive, and the patient was diagnosed with cilostazol-induced acute tubulointerstitial nephritis. Despite discontinuation of cilostazol, her renal function rapidly worsened and steroid pulse therapy was initiated, followed by oral high-dose glucocorticoid therapy. After steroid treatment, her serum creatinine level normalized in parallel with urine beta2-microglobulin.ConclusionCilostazol can induce acute tubulointerstitial nephritis.

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The use of gallium-67 scintigraphy in the diagnosis of acute interstitial nephritis

Cited by 28 publications

References 15 publications

Alogliptin-Induced Minimal Change Nephrotic Syndrome and Interstitial Nephritis

Alogliptin-Induced Minimal Change Nephrotic Syndrome and Interstitial Nephritis

Usefulness of 99mTc-dimercaptosuccinic acid renal scan in the diagnosis and follow-up of acute tubulointerstitial nephritis in children

Cilostazol-induced acute tubulointerstitial nephritis accompanied by IgA nephropathy: a case report

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