Nuclear medicine images of a kidney transplant on postoperative day 1 with delayed graft function secondary to acute tubular necrosis. Nuclear medicine images of a kidney transplant on postoperative day 1 with delayed graft function secondary to acute tubular necrosis. Dynamic images (A) of the study shows a normal prompt perfusion pattern to the transplanted kidney. Decreased excretion and clearance to transplant kidney are consistent with acute tubular necrosis. Trace bladder activity is noted. Radiopharmaceutical agent was 99mTc mertiatide (MAG3). (B) Regions of interest are drawn around the kidney. (C) Curves generated of the activity within that region as a function of time in ATN. Asif Sharfuddin CJASN 2014;9:416-429 ©2014 by American Society of Nephrology