Renal scintigraphy of the transplanted kidney: Innovative approaches to monitoring and prognostic value

The preferred treatment for severe chronic kidney disease (CKD) is kidney transplantation. However, delayed graft function and acute graft dysfunction resulting from acute tubular necrosis, rejection, cyclosporine toxicity, urine leak, hematoma, blockage, lymphocele, and renal artery stenosis are frequent post-transplant complications. Renal biopsy remains the gold standard for diagnosis, but it is invasive and associated with complications and sampling errors, underscoring the need for accurate non-invasive alternatives. Renal scintigraphy (RS) is a non-invasive nuclear imaging technique that uses radiopharmaceuticals to evaluate renal structure and function. It has demonstrated value in diagnosing complications such as acute tubular necrosis, acute allograft rejection, urine leakage, urinoma formation, and vesicoureteral reflux. Importantly, baseline RS performed in the early postoperative period may also provide prognostic information on long-term graft survival. Although several reviews have addressed the diagnostic role of RS in transplantation, less attention has been given to its prognostic applications, its integration with emerging techniques such as radiolabeled antibodies and hybrid imaging, and its potential to reduce reliance on invasive biopsies. This review, therefore, aims to synthesize current evidence on both the diagnostic and prognostic value of RS in kidney transplantation, with emphasis on recent innovations and future perspectives that distinguish it from earlier literature.