Case Author(s): Anton J. Johnson, M.D., Ph.D. and Tom R. Miller, M.D., Ph.D. , 9/13/96 . Rating: #D3, #Q4

Diagnosis: Focal Acute Tubular Necrosis

Brief history:

Hypertension, evaluate renal function.

Images:

Sequential one minute posterior images.

View main image(rs) in a separate image viewer

View second image(rs). Post-void image, approximately 30 minutes after beginning of study.

View third image(rs). Post-void image from a study performed six months later.

View fourth image(an). Renal artery angiogram.

Full history/Diagnosis is available below

Diagnosis: Focal Acute Tubular Necrosis

Full history:

56 year old female with hypertension and FMD (fibromuscular dysplasia) involving her renal arteries. Five days prior to the first renal scan, the patient had undergone revascularization of the lower of two right renal arteries for FMD (long segment involvement precluded treatment with angioplasty).

Radiopharmaceutical:

7.7 and 7.6 mCi Tc- 99m MAG3 i.v.for the 3-25-96 and 9-12-96 studies, respectively.

Findings:

There is parenchymal retention of activity in the right lower pole on the first renogram which resolves by the time of the second renal study six months later. Flow was normal on both studies. An angiogram performed prior to revascularization showed long-segment FMD involvement of the lower of two right renal arteries.

Discussion:

Acute tubular necrosis (ATN) has many causes. In cadaveric renal transplants the damage is thought to be due to ischemia occuring during the time between donor death and transplantation. It usually presents within the first few days after transplantation and resolves by three to four weeks. The scintographic findings characteristically include the combination of relatively preserved renal perfusion and poor tubular function. Given the patient's history of revascularization surgery involving the arterial supply to the right lower pole, the findings are most consistent with focal acute tubular necrosis, possibly due to ischemia during the operation.

References: Datz FL, et al: Nuclear Medicine, A Teaching File, St. Louis, Mosby, 1992, p151. Mettler FA, Guiberteau MJ: Essentials of Nuclear Medicine, 3rd ed. Philadelphia, W.B. Saunders, 1991, p247. Thrall JH, Ziessman HA: Nuclear Medicine, the Requisites, St. Louis, Mosby, 1995, p305.

Followup:

None

Major teaching point(s):

Although ATN is usually a diffuse process, it can be focal as illustrated by this case. The ATN resolved by the time of the second study six months after the revascularization surgery.

ACR Codes and Keywords:

References and General Discussion of Renal Scintigraphy (Anatomic field:Genitourinary System, Category:Effect of Trauma)

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Case number: rs011

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