Delayed images - at 24 hours - will show the previously photopaenic area as full of tracer, because the non-radioactive urine has been mixed with radioactive urine.
It is due to rupture (the renal equivalent of a AAA) of the pelvicalyceal system, usually during a period of strain such as when there is acute obstruction of the ureter, or when there is massive VUR, or from a retrograde pyelogram.
Thus, you get an encapsulated retroperitoneal urine collection sitting in the perinephric space.
Once it gets big enough, it will obstruct drainage from the kidney.
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