The Role of Technetium-99m MAG3 Renal Imaging in the Diagnosis of Acute Tubular Necrosis of Native Kidneys

Abstract

The differential diagnosis for patients with acute renal failure of their native kidneys, as a result of primary intrarenal disease, includes acute tubular necrosis, glomerulonephritis, and interstitial nephritis. The role of MAG3 renography has not been studied in this setting. The authors describe four patients with acute renal failure in whom MAG3 renal imaging reliably identified acute tubular necrosis, as confirmed by follow-up kidney biopsies. In contrast to the poor parenchymal uptake observed in glomerulonephritis and interstitial nephritis, MAG3 shows a distinctive pattern in patients with acute tubular necrosis. For patients with acute renal failure, a renal scan can facilitate decision-making regarding the initiation of therapy.

Serial Tc-99m MAG3 Renography Evaluating the Recovery of Acute Kidney Injury Associated with Minimal Change Nephrotic Syndrome

“…A pattern of renal scanning characterized by progressive accumulation of radiotracer with limited excretion has been demonstrated to have a diagnostic impact in patients with various obstructive uropathies, a reduced volume status and acute tubular injuries (6)(7)(8)(9)(10). Anecdotally, similar results of renal scanning in patients with nephrotic syndrome complicated by AKI due to clinically diagnosed renal ischemia have been previously described (11).…”

ACR Appropriateness Criteria® Renal Failure

“…Diuretic furosemide renography can help to confirm a dilated obstructed versus a dilated nonobstructed renal collecting system. A persistent nephrogram without excretion suggests acute tubular necrosis [25]. Measurement of effective renal plasma flow may provide prognostic information.…”