GALLIUM-67-CITRATE SCANNING OF RENAL PARENCHYMAL MALACOPLAKIA

The purpose of this article is to review the potential role of nuclear medicine scanning, especially with Ga-67, in the presumptive diagnosi s and clinical management of patients with renal parenchymal malacopla kia (RPMP), a rare disease associated with coliform bacterial infectio n of the kidney and characterized by chronic unresolving inflammatory infiltrates containing von Hansemann macrophages in the renal parenchy ma, Methods: Published cases of RPMP were collected from the archival literature by searching the MEDLINE database and by reviewing bibliogr aphic references contained in articles on malacoplakia. Data on the cl inical 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 p atients (23%) had Ga-67 scanning as a component oi their diagnostic ev aluation, In all 10 patients, renal uptake of Ga-67 was classified as intense. Two of those 10 patients had serial Ga-67 scanning performed to assess response to antibiotic treatment; both patients exhibited de creased uptake or complete resolution of abnormal renal uptake over ti me, a finding also exhibited by our patient. Conclusion: Intense renal uptake of Ga-67, typically in the clinical setting of fever, progress ive renal failure and nephromegaly, strongly supports a diagnosis of R PMP, In those patients receiving prolonged antimicrobial therapy for R PMP, resolution of abnormal Ga-67 uptake over time may provide an obje ctive endpoint for treatment.