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

## TL;DR

This paper reviews current and emerging radiopharmaceuticals used in kidney imaging, focusing on their role in assessing kidney function and potential future applications.

## Contribution

The paper systematically summarizes both conventional and emerging PET radiopharmaceuticals for renal imaging, highlighting their clinical potential.

## Key findings

- Conventional radiopharmaceuticals like 99mTc-DTPA and 99mTc-MAG3 are widely used for GFR and ERPF assessment.
- Emerging PET radiopharmaceuticals such as 68Ga-EDTA and 18F-FDS offer higher sensitivity and molecular insights for renal function evaluation.
- Additional PET tracers like 68Ga-PSMA-11 are being explored for assessing renal tumors and split renal function.

## Abstract

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 99mTc-DTPA, 99mTc-DMSA, 99mTc-MAG3, and 99mTc-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 68Ga-EDTA, 68Ga-DTPA, 68Ga-NOTA, 68Ga-DOTA, and 18F-FDS for GFR assessment and 11C-PABA, 18F-PFH, Re­(CO)3(18F-FEDA), and Al-18F-NODA-butyric acid for ERPF evaluation. Additional PET tracers,
including 68Ga-IRDye800-tilmanocept, 18F-FDG,
and 68Ga-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.