Service of Nuclear Medicine, Hospital de Base, Sao Jose do Rio Preto Medical School, Sao Jose do Rio Preto, Brazil.
Nephrol Dial Transplant. 2010 Oct;25(10):3277-82. doi: 10.1093/ndt/gfq152. Epub 2010 Mar 26.
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.
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.
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.
Ga-67 scintigraphy was extremely effective in the differentiation between experimental drug-induced ATN and AIN.
在急性肾损伤患者中，急性间质性肾炎（AIN）和急性肾小管坏死（ATN）的鉴别诊断至关重要。镓-67 枸橼酸盐（Ga-67）已在临床上用于这些实体之间的鉴别诊断，但疗效存在争议。本研究旨在评估 Ga-67 闪烁显像在药物诱导的 AIN 和 ATN 实验模型鉴别中的效果。
动物分为三组：AIN 组（n = 8）、ATN 组（n = 8）和对照组（NL 组，n = 10）。AIN 组给予腹腔内注射博来霉素氨基核苷（单次剂量 150mg/kg）。ATN 组给予单次腹腔注射顺铂（6mg/kg）。NL 组未给予活性药物。所有动物均接受 Ga-67 闪烁显像、血清肌酐（Cr）和尿渗透压评估以及盲法肾组织学评估。
与 ATN 组（P < 0.0001）和 NL 组（P < 0.001）相比，AIN 组的肾脏 Ga-67 摄取明显更高。与 NL 组相比，ATN 组的 Cr 升高（P < 0.001），尿渗透压降低（与 NL 组相比，P < 0.001；与 AIN 组相比，P < 0.01）。肾组织学显示 ATN 组存在严重的急性肾小管损伤，AIN 组存在强烈的间质炎症，对照组动物的肾脏组织学正常。
Ga-67 闪烁显像在实验性药物诱导的 ATN 和 AIN 鉴别中非常有效。
