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The absent kidney in ⁹⁹Tc^m-MAG3 renogram: a dramatic reversible consequence of contrast nephrotoxicity superimposed on renal obstruction

Institute of Nuclear Medicine, Middlesex Hospital, Mortimer Street, London W1T 3AA, UK

View larger version (60K): [in a new window]   Figure 1. Case 1: CT arterial phase renal angiogram (Siemens Somatom Plus 4 Volume Zoom, Forcheim, Germany). Coronal multiplanar reconstruction image; there is clear reduction in perfusion (enhancement) of the right kidney and gross dilatation of the renal calyces.

View larger version (89K): [in a new window]   Figure 2. Case 1: (a) 99Tcm-MAG3 renogram 4 days post CT angiogram. The right kidney appears to be absent, no tracer uptake can be identified in the right kidney. (b) Follow up renogram 2 days later, shows a poorly perfused right kidney with prolonged nephrogenic phase of activity. (c) 99Tcm-MAG3 renogram 6 weeks later following ureteric stent placement shows good perfusion, significant recovery of function and rapid excretion of tracer.

View larger version (51K): [in a new window]   Figure 3. Case 2: (a) 99Tcm-MAG3 renogram 5 days after high dose urography demonstrates severe reduction in perfusion and function of left kidney with no excretion of tracer. (b) Follow up renogram 6 weeks post placement of left nephrostomy (arrows); there is improved perfusion of left kidney, dramatic improvement in left renal function and normal excretion of tracer.