Vidal Enrico, Miorin Elisabetta, Zucchetta Pietro, Benetti Elisa, Longo Germana, Meneghesso Davide, Parolin Mattia, Murer Luisa
Nephrology, Dialysis and Transplant Unit, Department of Women's and Children's Health, University-Hospital of Padova, Padova, Italy.
Pediatric Clinic, DPMSC, University-Hospital of Udine, Udine, Italy.
Clin Kidney J. 2017 Oct;10(5):655-660. doi: 10.1093/ckj/sfx041. Epub 2017 Jun 12.
Symptoms 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 Tc-dimercaptosuccinic acid (DMSA) scintigraphy in the diagnosis and follow-up of ATIN.
We 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.
DMSA 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.
DMSA 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.
急性肾小管间质性肾炎（ATIN）的症状和体征是非特异性的；因此，往往需要进行肾活检以明确诊断。本研究的目的是评估锝-二巯基丁二酸（DMSA）肾闪烁显像在ATIN诊断及随访中的应用。
我们回顾性分析了5例（9个肾单位）中位年龄为14岁的患者的病历，这些患者在临床和/或活检证实为ATIN后接受了DMSA扫描。检查在疾病发作后1个月内进行，并在急性期后中位时间12个月时重复进行。
急性期进行的DMSA肾扫描发现了提示性结果，包括放射性核素肾摄取弥漫性降低以及在皮质髓质分布区存在多个“冷”局灶性病变。在接受类固醇治疗的2例患者和1例急性期出现轻度肾功能不全的患者中，随访闪烁显像结果正常。相比之下，对照扫描显示，1例因高血压再次入院的患者和1例急性期出现3期急性肾损伤的肾移植患者存在持续性肾损伤。
DMSA肾扫描可能是儿童ATIN早期无创诊断的可靠工具，对那些不适合进行肾活检的患者可能特别有用。此外，DMSA扫描可提供准确的随访评估，因为它可以监测急性肾实质炎症的演变以及潜在的肾瘢痕形成风险。由于样本量小，我们的研究结果有待在更大规模的研究中进一步验证。
