pH alterations are a hallmark of many pathologies including cancer and kidney disease. Here, we introduce [1,5-^(13)C(2)]Z-OMPD as a hyperpolarized extracellular pH and perfusion sensor for MRI which allows to generate a multiparametric fingerprint of renal disease status and to detect local tumor acidification. Exceptional long T(1) of two minutes at 1 T, high pH sensitivity of up to 1.9 ppm per pH unit and suitability of using the C(1)-label as internal frequency reference enables pH …