Diffusion-weighted MRI of exercise-induced acute renal failure (ALPE)
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BRIEF REPORT
Diffusion-weighted MRI of exercise-induced acute renal failure (ALPE) Kazuhide Ohta & Tadafumi Yokoyama & Masaki Shimizu & Kazunori Mizuno & Shinobu Sakazume & Takuma Fujiki & Yutaka Saikawa & Akihiro Yachie
Received: 13 September 2010 / Revised: 12 March 2011 / Accepted: 14 March 2011 / Published online: 20 May 2011 # IPNA 2011
Abstract Acute renal failure with severe loin pain induced by anaerobic exercise (ALPE) is a rare condition that is accompanied by wedge-shaped contrast enhancement on computed tomography (CT) without evidence of rhabdomyolysis. In two pediatric cases with ALPE, we tried to determine the relationship between findings from CT and magnetic resonance imaging (MRI). Case 1 involved a 13year-old Japanese girl with a diagnosis of ALPE with normo-uricemia. Contrast-enhanced CT after 24 and 48 h showed a wedge-shaped excretion delay for the contrast media. A clear wedge-shaped signal hyperintensity matching the CT images was obtained by diffusion-weighted MRI. Case 2 involved a 16-year-old boy who presented with a second attack of ALPE after diagnosis of ALPE with hypouricemia 1 year earlier. Only diffusion-weighted imaging was performed. Clear wedge-shaped signal hyperintensity was apparent, similar to Case 1. MRI is safer than contrastenhanced CT for patients with ALPE. Diffusion-weighted MRI is a very useful examination for diagnosing ALPE, providing noninvasive detection of lesions peculiar to ALPE. K. Ohta (*) : K. Mizuno : S. Sakazume Department of Pediatrics, Kanazawa Medical Center, National Hospital Organization, 1–1 Shimo-Ishibiki, Kanazawa, Ishikawa 920–8650, Japan e-mail: [email protected] T. Yokoyama : M. Shimizu : A. Yachie Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, Kanazawa, Japan T. Fujiki : Y. Saikawa Department of Pediatrics, Kanazawa Medical University Hospital, Uchinada, Ishikawa, Japan
Keywords Acute renal failure . Loin pain . Diffusion-weighted MRI . Wedge-shaped high-intensity signals
Introduction Acute kidney injury after strenuous exercise is well known to be induced by rhabdomyolysis. However, exercise-induced acute kidney injury without rhabdomyolysis was first reported by Ishikawa et al. [1] and was later renamed acute kidney injury with severe loin pain after anaerobic exercise (ALPE) [2]. Clinical characteristics of ALPE include reversible kidney dysfunction and temporary multiple wedge-shaped delayed enhancements visible on computed tomography (CT). The pathogenesis of ALPE is thus suspected to involve temporary patchy ischemia of the kidney resulting from reversible vasoconstriction of the renal vessels [2]. Although contrastenhanced CT is the gold standard for diagnosing ALPE, use of contrast media is potentially problematic for patients with renal dysfunction. On the other hand, the abnormal findings on diffusion-weighted magnetic resonance imaging (MRI) are known to suggest cytotoxic edema and/or vasogenic edema [3, 4]. According to a recent report, MRI helps
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