Radiopharmaceuticals in Renal Imaging: A Comprehensive Review of Current Applications and Future Prospects

High Resolution Image Download MS PowerPoint Slide The kidneys play a vital role in filtration, excretion, and metabolic regulation, making accurate functional assessment essential for diagnosis, monitoring, and management of renal diseases. While conventional imaging modalities such as ultrasonography, computed tomography (CT), and multiparametric magnetic resonance imaging (MRI) provide structural and functional information, nuclear medicine techniques enable more detailed evaluation of renal physiology at the molecular level. This review provides a comprehensive overview of functional renal imaging using both conventional renal scintigraphy and emerging positron emission tomography (PET) radiopharmaceuticals. Established renal scintigraphy radiopharmaceuticals, including 99m Tc-DTPA, 99m Tc-DMSA, 99m Tc-MAG3, and 99m Tc-EC, have long been applied to assess glomerular filtration rate (GFR) and effective renal plasma flow (ERPF). PET radiopharmaceuticals, offering higher sensitivity, superior quantification, and molecular insight, are increasingly investigated for similar purposes, with 68 Ga-EDTA, 68 Ga-DTPA, 68 Ga-NOTA, 68 Ga-DOTA, and 18 F-FDS for GFR assessment and 11 C-PABA, 18 F-PFH, Re(CO) 3 ( 18 F-FEDA), and Al- 18 F-NODA-butyric acid for ERPF evaluation. Additional PET tracers, including 68 Ga-IRDye800-tilmanocept, 18 F-FDG, and 68 Ga-PSMA-11, have been explored for glomerular mesangial function, renal tumors, and split renal function, respectively. By systematically summarizing both renal scintigraphy and PET approaches, this review highlights current and emerging PET radiopharmaceuticals for renal functional imaging and discusses their potential clinical applications and future perspectives in precision nephrology.