Urinary reflux to the non-functioning previous renal graft

Nuclear medicine imaging is routinely used for evaluation of perfusion and function of the transplanted kidneys. At present, the radiopharmaceutical of choice for this study in our center is Tc 99m-Ec. Complications of the kidney graft are demonstrable in the early and delayed images. One of these complications is vesicoureteral reflux to the graft or to the native kidneys. We present a 27 year old patient with elevated BUN and Cr ten days after kidney transplantation. He previously had failed renal transplantation due to rejection. Tc-99m EC renal scan revealed decreased perfusion and function suggesting acute rejection. In the late functional images (at 24 minute), vesicoureteral reflux to the previous non-functioning graft was also noticed on the right side of the pelvis. We recommend considering vesicouretral reflux while interpreting renal transplant imaging since this can be easily mistaken with other complications such as urine leakage.