Chronic renal failure caused by hypertension or by parenchymal kidney disease is a very common global health problem. Patients with chronic renal failure have two therapeutic options, dialysis and transplantation, of which transplantation has become a preferred modality. This review article is an update of a more comprehensive previous review (Semin Nucl Med, 181-198, 1988) and concentrates on the changes that have taken place in this field in recent years. These changes comprise new criteria for the selection of transplant candidates, newer techniques for the diagnosis of medical and surgical complications after transplantation, the use of new tracers (Tc-99m MAG3), and new antirejection regimens. © 1995 W.B. Saunders Company.