A new renal imaging agent, technetium-99m mercaptoacetyltriglycine (MAG3, mertiatide), is currently undergoing clinical trials. Like iodine-131 orthoiodohippurate (OIH)--and unlike all other available agents--it is avidly secreted by the renal tubules. Fifty patients underwent simultaneous renal imaging studies with I-131 OIH and Tc-99m MAG3. The superior physical properties of the Tc-99m label led to better image quality in all cases, largely due to count rates that were 50-fold better. In two patients, lesions were seen with MAG3 that were not visible with OIH. The biological properties of the two agents were found to be so similar that conventional diagnostic criteria for I-131 OIH could be used for Tc-99m MAG3 with only minor modifications.