Spontaneously resolving lower polar ATN in a transplant kidney with dual vascular supply demonstrated on 99mTc EC renography.

We report the presence of a differential acute tubular necrosis pattern on renography in a renal transplant recipient who had received a donor kidney with dual renal arterial supply. The proximal accessory renal artery was supplying the lower pole which had been demonstrated on CT angiography. This possibility should be kept in mind while reporting renography with tubular agents like 99mTc EC in transplant patients. Follow-up renography effectively demonstrated spontaneous resolution of the differential retention pattern and acute tubular necrosis. This case reiterates the usefulness of retention of tubular tracers like 99mTc EC for detection of tubular necrosis.