Bakir A A, Lopez-Majano V, Levy P S, Rhee H L, Dunea G
Division of Nephrology and Nuclear Medicine, Cook County Hospital, Chicago, IL.
Am J Kidney Dis. 1988 Dec;12(6):481-6. doi: 10.1016/s0272-6386(88)80098-2.
To evaluate the diagnostic usefulness of gallium 67 scintigraphy in glomerular disease, 45 patients with various glomerulopathies, excluding lupus nephritis and renal vasculitis, were studied. Persistent renal visualization 48 hours after the gallium injection, a positive scintigram, was graded as + (less than), ++ (equal to), and +++ (greater than) the hepatic uptake. Positive scintigrams were seen in ten of 16 cases of focal segmental glomerulosclerosis, six of 11 cases of proliferative glomerulonephritis, and one case of minimal change, and one of two cases of membranous nephropathy; also in three of six cases of sickle glomerulopathy, two cases of diabetic neuropathy, one of two cases of amyloidosis, and one case of mild chronic allograft rejection. The 25 patients with positive scans were younger than the 20 with negative scans (31 +/- 12 v 42 +/- 17 years; P less than 0.01), and exhibited greater proteinuria (8.19 +/- 7.96 v 2.9 +/- 2.3 S/d; P less than 0.01) and lower serum creatinine values (2 +/- 2 v 4.1 +/- 2.8 mg/dL; P less than 0.01). The amount of proteinuria correlated directly with the intensity grade of the gallium image (P less than 0.02), but there was no correlation between the biopsy diagnosis and the outcome of the gallium scan. It was concluded that gallium scintigraphy is not useful in the differential diagnosis of the glomerular diseases under discussion. Younger patients with good renal function and heavy proteinuria are likely to have a positive renal scintigram regardless of the underlying glomerulopathy.
为评估镓67闪烁扫描术在肾小球疾病中的诊断价值，我们对45例各种肾小球病变患者进行了研究，这些患者不包括狼疮性肾炎和肾血管炎。在注射镓48小时后持续的肾脏显影，即阳性闪烁图，根据肝脏摄取情况分为 +（低于）、++（等于）和 +++（高于）。在16例局灶节段性肾小球硬化症患者中有10例出现阳性闪烁图，11例增殖性肾小球肾炎患者中有6例，微小病变患者1例，膜性肾病患者2例中有1例；在6例镰状肾小球病患者中有3例，糖尿病性神经病变患者2例，淀粉样变性患者2例中有1例，轻度慢性移植物排斥反应患者1例。扫描结果为阳性的25例患者比扫描结果为阴性的20例患者年轻（31±12岁对42±17岁；P<0.01），蛋白尿更多（8.19±7.96对2.9±2.3 S/d；P<0.01），血清肌酐值更低（2±2对4.1±2.8 mg/dL；P<0.01）。蛋白尿的量与镓图像的强度分级直接相关（P<0.02），但活检诊断与镓扫描结果之间没有相关性。得出的结论是，镓闪烁扫描术对所讨论的肾小球疾病的鉴别诊断没有帮助。无论潜在的肾小球病变如何，肾功能良好且蛋白尿严重的年轻患者可能有阳性肾脏闪烁图。
