Allergic Interstitial Nephritis Manifesting as a Striated Nephrogram

Allergic interstitial nephritis (AIN) is an underdiagnosed cause of acute kidney injury (AKI). Guidelines suggest that AIN should be suspected in a patient who presents with an elevated serum creatinine and a urinalysis that shows white cells, white cell casts, or eosinophiluria. Drug-induced AIN is suspected if AKI is temporally related to the initiation of a new drug. However, patients with bland sediment and normal urinalysis can also have AIN. Currently, a definitive diagnosis of AIN is made by renal biopsy which is invasive and fraught with risks such as bleeding, infection, and hematoma. Additionally, it is frequently unclear when a kidney biopsy should be undertaken. We describe a biopsy proven case of allergic interstitial nephritis which manifested on contrast enhanced Magnetic Resonance Imaging (MRI) as a striated nephrogram. Newer and more stable macrocyclic gadolinium contrast agents have a well-demonstrated safety profile. Additionally, in the presentation of AKI, gadolinium contrast agents are safe to administer in patients who demonstrate good urine output and a downtrending creatinine. We propose that the differential for a striated nephrogram may include AIN. In cases in which the suspicion for AIN is high, this diagnostic consideration may be further characterized by contrast enhanced MRI.

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Intraindividual In Vivo Comparison of Gadolinium Contrast Agents for Pharmacokinetic Analysis Using Dynamic Contrast Enhanced Magnetic Resonance Imaging

Investigative Radiology ◽

10.1097/rli.0b013e3181d54507 ◽

2010 ◽

Vol 45 (5) ◽

pp. 233-244 ◽

Cited By ~ 14

Author(s):

Jiachao Liang ◽

Steffen Sammet ◽

Xiangyu Yang ◽

Guang Jia ◽

Yukihisa Takayama ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Contrast Agents ◽

Pharmacokinetic Analysis ◽

Resonance Imaging ◽

Gadolinium Contrast ◽

Dynamic Contrast Enhanced ◽

Contrast Enhanced ◽

Gadolinium Contrast Agents

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Diagnostic value of DWI-MRI for the detection of acute plaques in the relapse phase of multiple sclerosis

Romanian Journal of Neurology ◽

10.37897/rjn.2021.1.5 ◽

2021 ◽

Vol 20 (1) ◽

pp. 35-40

Author(s):

Mehran Yousefi ◽

◽

Mehdi Panahali ◽

Kamran Azarkhish ◽

Nazanin Azizi Shalbaf ◽

...

Keyword(s):

Multiple Sclerosis ◽

Predictive Value ◽

Brain Mri ◽

Diagnostic Value ◽

Gadolinium Contrast ◽

Mcdonald Criteria ◽

Contrast Enhanced ◽

Gadolinium Contrast Agents ◽

Magnetic Resonance Imaging Mri ◽

Sensitivity Specificity

Background. The 2010 revision of the McDonald criteria, widely used for the diagnosis of multiple sclerosis (MS), has established that dissemination in time (DIT) can be demonstrated by the simultaneous presence of asymptomatic gadolinium-enhancing and non-enhancing plaques on a single magnetic resonance imaging (MRI). When the use of gadolinium contrast agents is contraindicated, diffusion-weighted imaging (DWI) is utilized to confirm diffusion alterations in active inflammatory plaques. This study intended to examine whether DWI can be a viable alternative to contrast-enhanced T1-weighted imaging for demonstrating DIT in MS. Material and methods.We assessed 30 previously diagnosed MS patients during acute relapse (based on the 2010 McDonald criteria) and evaluated their brain MRI via DWI‚ contrast-enhanced T1-weighted imaging, and FLAIR sequences. Asymptomatic plaques were defined as either hyperintense or non-hyperintense in DWI and enhancing or non-enhancing in T1GAD-MRI. Statistical indices for the prediction of plaque enhancement in T1 GAD-MRI via DWI-MRI were calculated and compared. Results. The 30 participants in our study had a total of 925 demyelinating plaques that were larger than 3mm in size and presented to be hyperintense in FLAIR-MRI. Diffusion hyperintensity and plaque enhancement were significantly correlated. The sensitivity‚ specificity, positive predictive value‚ negative predictive value, and accuracy of DWI were calculated to be 69.66%‚ 99.76%‚ 96.88%‚ 96.86%, and 96.86%, respectively. Conclusions. Hyperintense DWI findings do not necessarily overlap with contrast enhancements in T1 GAD-MRI. DWI was shown to produce a higher rate of false-positive results. Our study concludes that although T1 GAD-MRI should not be replaced by DWI to determine DIT due to its lower specificity, DWI’s continued use as a surrogate screening imaging sequence whenever the use of T1GAD-MRI is of concern is not without its merits.

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MRI in Pregnancy and Precision Medicine: A Review from Literature

Journal of Personalized Medicine ◽

10.3390/jpm12010009 ◽

2021 ◽

Vol 12 (1) ◽

pp. 9

Author(s):

Gianluca Gatta ◽

Graziella Di Grezia ◽

Vincenzo Cuccurullo ◽

Celestino Sardu ◽

Francesco Iovino ◽

...

Keyword(s):

Contrast Agents ◽

Blood Pool ◽

Placental Barrier ◽

Negative Effects ◽

Gadolinium Contrast ◽

Imaging Results ◽

Gadolinium Contrast Agents ◽

Magnetic Resonance Imaging Mri ◽

Abdominal And Pelvic Pain ◽

Ionizing Radiations

Magnetic resonance imaging (MRI) offers excellent spatial and contrast resolution for evaluating a wide variety of pathologies, without exposing patients to ionizing radiations. Additionally, MRI offers reproducible diagnostic imaging results that are not operator-dependent, a major advantage over ultrasound. MRI is commonly used in pregnant women to evaluate, most frequently, acute abdominal and pelvic pain or placental abnormalities, as well as neurological or fetal abnormalities, infections, or neoplasms. However, to date, our knowledge about MRI safety during pregnancy, especially about the administration of gadolinium-based contrast agents, which are able to cross the placental barrier, is still limited, raising concerns about possible negative effects on both the mother and the health of the fetus. Contrast agents that are unable to cross the placenta in a way that is safe for the fetus are desirable. In recent years, some preclinical studies, carried out in rodent models, have evaluated the role of long circulating liposomal nanoparticle-based blood-pool gadolinium contrast agents that do not penetrate the placental barrier due to their size and therefore do not expose the fetus to the contrast agent during pregnancy, preserving it from any hypothetical risks. Hence, we performed a literature review focusing on contrast and non-contrast MRI use during pregnancy.

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Faculty Opinions recommendation of Native T1-mapping detects the location, extent and patterns of acute myocarditis without the need for gadolinium contrast agents.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718430620.793522447 ◽

2016 ◽

Author(s):

Udo Sechtem ◽

Simon Greulich

Keyword(s):

Contrast Agents ◽

T1 Mapping ◽

Acute Myocarditis ◽

Gadolinium Contrast ◽

Native T1 ◽

Gadolinium Contrast Agents

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Acute interstitial nephritis and drug-induced systemic lupus erythematosus due to chlorthalidone and amiodarone: A case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x20910029 ◽

2020 ◽

Vol 8 ◽

pp. 2050313X2091002 ◽

Cited By ~ 1

Author(s):

Umut Selamet ◽

Ramy M Hanna ◽

Anthony Sisk ◽

Lama Abdelnour ◽

Lena Ghobry ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Interstitial Nephritis ◽

Lupus Erythematosus ◽

Kidney Biopsy ◽

Kidney Injury ◽

Acute Interstitial Nephritis ◽

Systemic Lupus ◽

Drug Induced ◽

Systemic Manifestations

Drug-induced lupus erythematosus has features distinct from primary systemic lupus erythematosus. It can occur with a wide variety of agents that result in the generation of anti-histone or other types of antibodies. Systemic manifestations of drug-induced systemic lupus erythematosus may include renal dysfunction due to circulating immune complexes or due to other immune reactions to the culprit medication(s). Acute interstitial nephritis occurs due to DNA–drug or protein–drug complexes that trigger an allergic immune response. We report a patient who developed acute kidney injury, rash, and drug-induced systemic lupus diagnosed by serologies after starting chlorthalidone and amiodarone. A renal biopsy showed acute interstitial nephritis and not lupus-induced glomerulonephritis. It is important to note that systemic lupus erythematosus and acute interstitial nephritis can occur together, and this report highlights the role of the kidney biopsy in ascertaining the pathological diagnosis and outlining therapy in drug-induced lupus erythematosus.

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