Rev Esp Med Nucl Imagen Mol. 2012;31(3):155–157 Clinical note Mercaptoacetyltriglycine renal scan for the differential diagnosis of acute tubular necrosis and interstitial nephritis associated to vancomycin G.K. Gedik a,* , F. Yılmaz b , B. Kaya b , P.Ö. Kara a , O. Sarı a a Selcuk University, Selcuklu Medical Faculty, Department of Nuclear Medicine, Konya, Turkey b Konya University, Meram Medical Faculty, Department of Nuclear Medicine, Konya, Turkey article info Article history: Received 28 October 2011 Accepted 24 November 2011 Available online 14 March 2012 Keywords: Vancomycin Renal toxicity Tc-99m MAG3 Renal scan abstract The differential diagnosis of vancomycin associated renal toxicity includes acute tubular necrosis and interstitial nephritis. We report a case of vancomycin induced renal toxicity shown by Tc-99m mercap- toacetyltriglycine renal scan. Nephrotoxicity was evolved secondary to vancomycin used for treating a patient with meningitis. Tc-99m mercaptoacetyltriglycine renal scan may play a role in differentiation between acute tubular necrosis and tubulointerstitial nephritis of vancomycin associated renal toxicity and can facilitate the clinical decision making. © 2011 Elsevier España, S.L. and SEMNIM. All rights reserved. Renograma con mercaptoacetiltriglicina para el diagnóstico diferencial de necrosis tubular aguda y nefritis intersticial asociada a vancomicina Palabras clave: Vancomicina Toxicidad renal 99m Tc-MAG3 Renograma resumen El diagnóstico diferencial de toxicidad renal asociada a la vancomicina incluye la necrosis tubular aguda y la nefritis intersticial. Se presenta un caso de toxicidad renal inducida por vancomicina, demostrada en el renograma con 99m Tc-MAG3. La nefrotoxicidad se desarrolló secundariamente a vancomicina utilizada en el tratamiento de un paciente con meningitis. El renograma con 99m Tc-MAG3 puede desempe ˜ nar un papel en el diagnóstico diferencial entre necrosis tubular aguda y nefritis tubulointersticial en caso de toxicidad renal asociada a vancomicina y puede facilitar la toma de decisiones clínicas. © 2011 Elsevier España, S.L. y SEMNIM. Todos los derechos reservados. Introduction Vancomycin induced nephrotoxicity has been reported to manifest as acute tubulointerstitial nephritis. 1 In patients with preexisting renal disease and sepsis or in the setting of concomi- tant therapy with aminoglicoside, acute tubular necrosis may also occur. 1–3 Dynamic renal scintigraphy is routinely applied in most nuclear medicine departments for the functional evaluation of kidney function and is a useful tool for clinicians. Since its first introduc- tion in 1986, technetium-99m (Tc-99m) mercaptoacetyltriglcine (MAG3), a tubular agent, has replaced the Tc-99m diethylene- triaminepentaacetic acid (DTPA) as a tracer for functional renal studies because of the favorable imaging characteristics of the for- mer one. Herein we describe a patient with meningitis in whom elevation in blood urea nitrogen and creatinine serum levels were observed after high dose vancomycin administration. Tc-99m MAG3 renal scan revealed diffuse parenchymal retention in both kidneys. * Corresponding author. E-mail address: goncakara@yahoo.com (G.K. Gedik). Tubular dysfunction was attributed to vancomycin associated tubu- lar necrosis. Tc-99m MAG3 renal scan played a great role in the differential diagnosis of vancomycin induced renal toxicity. To our knowledge, this is the first report in which findings of MAG3 renal scan in vancomycin associated nephrotoxicty have been demon- strated. Case A 6-year-old boy was referred to nuclear medicine department for the assessment of kidney functions with Tc-99m MAG3 renal scan. From his history it was learnt that, he was admitted to our hospital 2 weeks ago suffering from fever, headache and vomiting. In physical examination, neck rigidity was suspicious so lumbar puncture was performed. Cerebrospinal fluid culture was positive for proteus mirabilis. Vancomycin was ordered as 60 mg/kg/day but was misadministered as 4 × 650 mg in a day for 12 days. Four days after the initiation of vancomycin therapy, the patient started to complain about abdominal pain. Renal ultrasound demonstrated enlargement in both kidneys and longitudinal dimensions were 108 mm and 100 mm for left and right kidney, respectively. Bilateral grade 1 increase in parenchyma echogenities were also reported in ultrasonography. Serum concentrations of urea nitrogen (BUN) 2253-654X/$ – see front matter © 2011 Elsevier España, S.L. and SEMNIM. All rights reserved. doi:10.1016/j.remn.2011.11.013