Ga-67 scintigraphy in the differential diagnosis between acute interstitial nephritis and acute tubular necrosis: an experimental study

Joaquim, A.I.; Mendes, Glória Elisa Florido; Ribeiro, Patrícia F. F.; Baptista, Maria Alice Sperto Ferreira; Burdmann, Emmanuel A.

doi:10.1093/ndt/gfq152

Cited by 19 publications

(12 citation statements)

References 13 publications

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“…Imaging of the kidneys with 67 gallium scan has been employed in the evaluation of AIN for the past 30 years [ 20 , 21 ]. Kidneys with AIN enhance as a result up the binding of 67 gallium to lactoferrin, which is produced and released by leukocytes within the interstitium [ 20 ]. In addition, lactoferrin is found on the surface of invading inflammatory cells, primarily lymphocytes, and also binds gallium [ 20 ].…”

Section: Imaging Modalitiesmentioning

confidence: 99%

“…Kidneys with AIN enhance as a result up the binding of 67 gallium to lactoferrin, which is produced and released by leukocytes within the interstitium [ 20 ]. In addition, lactoferrin is found on the surface of invading inflammatory cells, primarily lymphocytes, and also binds gallium [ 20 ]. Thus, gallium would be expected to enhance kidneys with AIN.…”

Section: Imaging Modalitiesmentioning

confidence: 99%

“…Thus, gallium would be expected to enhance kidneys with AIN. An investigation in rats demonstrated that 67 gallium scanning was highly accurate in differentiating experimentally induced AIN from both drug-induced ATN and normal rat kidneys [ 20 ]. In humans, there have been both promising study results as well as suboptimal test performance with this modality.…”

Section: Imaging Modalitiesmentioning

confidence: 99%

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Diagnosing drug-induced AIN in the hospitalized patient: A challenge for the clinician

Perazella¹

2014

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Drug-induced acute interstitial nephritis (AIN) is a relatively common cause of hospital-acquired acute kidney injury (AKI). While prerenal AKI and acute tubular necrosis (ATN) are the most common forms of AKI in the hospital, AIN is likely the next most common. Clinicians must differentiate the various causes of hospital-induced AKI; however, it is often difficult to distinguish AIN from ATN in such patients. While standardized criteria are now used to classify AKI into stages of severity, they do not permit differentiation of the various types of AKI. This is not a minor point, as these different AKI types often require different therapeutic interventions. Clinicians assess and differentiate AIN from these other AKI causes by utilizing clinical assessment, various imaging tests, and certain laboratory data. Gallium scintigraphy has been employed with mixed results. While a few serum tests, such as eosinophilia may be helpful, examination of the urine with tests such as dipstick urinalysis, urine chemistries, urine eosinophils, and urine microscopy are primarily utilized. Unfortunately, these tools are not always sufficient to definitively clinch the diagnosis, making it a challenging task for the clinician. As a result, kidney biopsy is often required to accurately diagnose AIN and guide management.

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Section: Imaging Modalitiesmentioning

confidence: 99%

Section: Imaging Modalitiesmentioning

confidence: 99%

Section: Imaging Modalitiesmentioning

confidence: 99%

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Diagnosing drug-induced AIN in the hospitalized patient: A challenge for the clinician

Perazella¹

2014

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“…Thus, noninvasive diagnostic tests for AIN would be helpful for patients who are not candidates for kidney biopsy. Gallium-67 scintigraphy has been suggested as a safe and noninvasive technique to aid in the diagnosis of AIN [ 7 – 10 ]. Gallium-67 is a radiotracer that binds to inflammatory proteins such as lactoferrin [ 10 ] and thus pools up at the sites of inflammation.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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BackgroundGallium-67 scintigraphy has been suggested as a noninvasive method to diagnose acute interstitial nephritis (AIN). However, its diagnostic performance and usefulness remain controversial.MethodsWe retrospectively reviewed the charts of 76 patients who underwent gallium-67 scintigraphy for a suspicion of AIN. Patients were classified based on kidney biopsy and/or clinical probability of AIN. Gallium-67 scintigraphy results were reinterpreted blindly using both posterior planar and single photon emission computed tomography (SPECT) imaging. Intensity of radioisotope uptake in the kidney was graded from 0 to 5.ResultsThe diagnosis of AIN was confirmed in 23 patients and excluded in 44. Nine patients with an uncertain diagnosis were excluded from subsequent analysis. A gallium-67 kidney uptake cutoff of 1 gave a negative predictive value of 100%, whereas a cutoff of 5 had an excellent specificity and positive predictive value for the diagnosis of AIN. When using a cutoff of 3, which had previously been used in the literature, we obtained a sensitivity of 61% and a specificity of 75% with posterior planar imaging. The results of both SPECT and posterior planar imaging modalities were comparable.ConclusionsGallium-67 scintigraphy may be of interest in patients with a clinical suspicion of AIN, especially in those who are unable to undergo kidney biopsy. However, results need to be interpreted with caution and depend on the intensity of gallium-67 kidney uptake.

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“…As an alkylating agent, cisplatin cause cell death to cancer cells after crosslinking to DNA. However, its chemotherapeutic efficacy is hampered by severe side effects especially nephrotoxicity (dos Joaquim et al, 2010). Kidneys are particularly affected by cisplatin due to (a) high amount of cisplatin accumulation in the kidneys and (b) the specific renal transport systems for cisplatin.…”

Section: Introductionmentioning

confidence: 99%

Pharmacological inhibition of NADPH oxidase protects against cisplatin induced nephrotoxicity in mice by two step mechanism

Wang

Luo²,

Pān

et al. 2015

Food and Chemical Toxicology

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Ga-67 scintigraphy in the differential diagnosis between acute interstitial nephritis and acute tubular necrosis: an experimental study

Abstract: Ga-67 scintigraphy was extremely effective in the differentiation between experimental drug-induced ATN and AIN.

Cited by 19 publications

References 13 publications

Diagnosing drug-induced AIN in the hospitalized patient: A challenge for the clinician

Diagnosing drug-induced AIN in the hospitalized patient: A challenge for the clinician

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

Pharmacological inhibition of NADPH oxidase protects against cisplatin induced nephrotoxicity in mice by two step mechanism

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