Gallium-67-citrate scanning of renal parenchymal malacoplakia
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Published on: April 28, 2013
T K Houston1, J E Peacock, R G Appel
1Department of Internal Medicine, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina 27157, USA.
Unlabelled:
The purpose of this article is to review the potential role of nuclear medicine scanning, especially with 67Ga, in the presumptive diagnosis and clinical management of patients with renal parenchymal malacoplakia (RPMP), a rare disease associated with coliform bacterial infection of the kidney and characterized by chronic unresolving inflammatory infiltrates containing von Hansemann macrophages in the renal parenchyma.
Methods:
Published cases of RPMP were collected from the archival literature by searching the MEDLINE database and by reviewing bibliographic references contained in articles on malacoplakia. Data on the clinical features and radiographic evaluation of patients with RPMP were extracted from the clinical case reports.
Results:
Forty-three cases of RPMP published over the past 20 yr were identified. Ten of the 43 patients (23%) had 67Ga scanning as a component of their diagnostic evaluation. In all 10 patients, renal uptake of 67Ga was classified as intense. Two of those 10 patients had serial 67Ga scanning performed to assess response to antibiotic treatment; both patients exhibited decreased uptake or complete resolution of abnormal renal uptake over time, a finding also exhibited by our patient.
Conclusion:
Intense renal uptake of 67Ga, typically in the clinical setting of fever, progressive renal failure and nephromegaly, strongly supports a diagnosis of RPMP. In those patients receiving prolonged antimicrobial therapy for RPMP, resolution of abnormal 67Ga uptake over time may provide an objective endpoint for treatment.
Insights
Nuclear medicine scanning with 67Ga shows intense renal uptake in patients with renal parenchymal malacoplakia (RPMP). This finding aids diagnosis and monitoring treatment response in this rare kidney infection.
Area of Science:
- Nuclear Medicine
- Radiology
- Infectious Diseases
Background:
- Renal parenchymal malacoplakia (RPMP) is a rare kidney disease characterized by chronic inflammation and bacterial infection.
- Diagnosis and management of RPMP can be challenging due to its rarity and unresolving inflammatory infiltrates.
Observation:
- A review of 43 published cases of RPMP identified 10 patients who underwent 67Ga scanning.
- All 10 patients exhibited intense renal uptake of 67Ga, a key diagnostic indicator.
Findings:
- Intense renal 67Ga uptake, particularly with symptoms like fever, renal failure, and nephromegaly, strongly suggests RPMP.
- Serial 67Ga scans in two patients demonstrated decreased uptake over time, correlating with successful antibiotic treatment.
Implications:
- 67Ga scanning plays a crucial role in the presumptive diagnosis of RPMP.
- Resolution of abnormal 67Ga uptake can serve as an objective marker for treatment efficacy in RPMP patients.
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