Clinical History
The patient is a 76-year-old female with decreasing renal function. This examination is requested to
evaluate for renal abnormality.
Technique
The patient received an intravenous injection containing 10 millicuries of 67-gallium citrate and 24 and 48
hour delayed whole body anterior and posterior images were obtained.
Findings
On the 24 hour image, there is a normal distribution of gallium throughout the body. Activity is noted
diffusely within the kidneys, which is normal at this time. Excretion is seen into the colon. There is mildly increased uptake within the hilar regions within the thorax. No other abnormal focus of activity is identified.
At 48 hours, there continues to be normal excretion of activity into the colon. There is persistent activity within the kidneys diffusely. This is abnormal at 48 hours after radio-isotope injection. There continues to be mildly increased uptake within the hila of the
lungs bilaterally. No other abnormal focus of activity is detected.
Impressions
PERSISTENT INCREASED UPTAKE WITHIN THE KIDNEYS BILATERALLY. THE ACTIVITY IS DIFFUSELY DISTRIBUTED WITHIN THE KIDNEY WITHOUT FOCAL HETEROGENEITY.
THIS FINDING IS CONSISTENT WITH INTERSTITIAL NEPHRITIS; HOWEVER,DRUG TOXICITY AND
ACUTE RENAL FAILURE OR ATN CAN ALSO GIVEN THIS APPEARANCE.
Comments
The bone scan only demostrates a slight amount of uptake in the kidneys bilaterally, which is considered to be within normal limits.
Biopsy Results
A percutaneous renal biopsy of the left kidney was performed 2 days after the Gallium injection, secondary to a continued rise in the patient's creatinine level, despite treatment for presumed pyelonephritis. The biopsy showed an acute severe tubulointerstitial nephritis. She was treated with Prednisone 40 mg/day which resulted in a decrease in her creatinine level.