Renal nuclear medicine: can it survive the millennium?

Much of the progress in renal nuclear medicine has been driven by technological development, but without rigorous assessment the value of some of these studies has been overestimated. The only tests to achieve gold standard status are the isotopic GFR, the DMSA renogram to detect cortical abnormalities and the captopril renogram when used to define those hypertensive patients who will not benefit from renovascular intervention. Consensus guidelines must be followed and routine protocols for combination tests must be developed, but even so isotopic renography is likely to be overtaken by competing technologies which can provide one test to give simultaneous information about both structure and function.