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Figure 22. 99mTc-MAG3 scan in a renal transplant with moderate acute tubular necrosis (ATN). Perfusion (A) is normal. On the sequential images (B), initial uptake is good and there is excretion by 3-4 minutes. Parenchymal retention in the kidney is seen at the end of the study. The persistent activity can be appreciated on the renogram curve (C).

Figure 23. 99mTc-MAG3 scan in patient with severe acute tubular necrosis (ATN). Perfusion (A) is mildly imparied. The sequential images (B) show good uptake but excretion is greatly delayed and there is progressive accumulation of tracer in the kidney throughout the study. Ureteric obstruction is unlikely, because some activity does reach the bladder (though many transplant recipients have some residual function in their native kidneys which might be responsible for the bladder activity). If there is concern for obstruction, an ultrasound is usually helpful. The renogram curve (C) shows increasing activity in the transplant.

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