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

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2010-10, Vol.25 (10), p.3277-3282
• Main Authors: Joaquim, Adriana I., Mendes, Glória E. F., Ribeiro, Patrícia F. F., Baptista, Maria Alice F., Burdmann, Emmanuel A.
• Format: Article
• Language: English
• Subjects: Acute Disease; acute interstitial nephritis; acute kidney injury; Acute Kidney Injury - diagnostic imaging; acute tubular necrosis; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Animals; Biological and medical sciences; Diagnosis, Differential; Emergency and intensive care: renal failure. Dialysis management; experimental study; Ga-67 scintigraphy; Gallium Radioisotopes; Intensive care medicine; Interstitial nephritis; Kidney - pathology; Kidney - physiopathology; Kidney Tubular Necrosis, Acute - diagnostic imaging; Kidney Tubular Necrosis, Acute - physiopathology; Male; Medical sciences; Nephritis, Interstitial - diagnostic imaging; Nephritis, Interstitial - physiopathology; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Radionuclide Imaging; Rats; Rats, Wistar
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfq152

Background. The differentiation between acute interstitial nephritis (AIN) and acute tubular necrosis (ATN) is crucial in patients with acute kidney injury. Gallium-67 citrate (Ga-67) has been used clinically in the differential diagnosis between these entities, but its efficacy is disputed. The aim of this study was to evaluate Ga-67 scintigraphy efficacy in the differentiation between experimental models of drug-induced AIN and ATN. Methods. Animals were divided into three groups: AIN (n = 8), ATN (n = 8) and control (NL, n = 10). The AIN group received intraperitoneal puromycin aminonucleoside (single dose, 150 mg/kg). The ATN group received a single intraperitoneal injection of cisplatin (6 mg/kg). The NL group did not receive active drugs. All of the animals were submitted to Ga-67 scintigraphy, serum creatinine (Cr) and urinary osmolality assessment, and blinded renal histology evaluation. Results. Renal Ga-67 uptake was strikingly more intense in the AIN group when compared to the ATN (P < 0.0001) and NL (P < 0.001) groups. The ATN group had increased Cr when compared to the NL group (P < 0.001) and lower urinary osmolality vs the NL (P < 0.001) and AIN (P < 0.01) groups. Renal histology showed severe acute tubular injury in the ATN group and intense interstitial inflammation in the AIN group, and was normal in control animals. Conclusion. Ga-67 scintigraphy was extremely effective in the differentiation between experimental drug-induced ATN and AIN.