Radiation nephropathy is renal injury caused by a sufficient dose of irradiation. It can result from external beam irradiation or internal irradiation as might occur from therapeutic radioisotopes. Its usual clinical presentation is as chronic kidney disease occurring some months after irradiation, and it can evolve to end-stage-renal-disease. While the immediate cellular injury from irradiation depends on radiolysis of water and oxidative DNA damage, there is no conclusive evidence for chronic persistent oxidative stress or inflammation as the cause of the multi-tissue scarring that ensues. Antagonists of the renin-angiotensin system are effective treatments for experimental radiation nephropathy but their preferential value in human clinical medicine is unproven.
Van SlyckEJBermudezGA. Radiation nephritis. Yale J Biol Med1968; 41: 243–256.
7.
FrenkelEPDouglassCCMcCallMS. Hypoerythropoietinemia and anemia. Arch Intern Med1970; 125: 1050–1055.
8.
DawsonLAKavanaghBDPaulinoAC, et al. Radiation-associated kidney injury. Int J Radiat Oncol Biol Phys2010; 76(3): S108–S115.
9.
AntignacCGublerMCLevergerG, et al. Delayed renal failure with extensive mesangiolysis following bone marrow transplantation. Kidney Int1989; 35: 1336–1344.
10.
DelgadoJCooperNThomsonK, et al. The importance of age, fludarabine, and total body irradiation in the incidence and severity of chronic renal failure after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant2006; 12: 75–83.
11.
JansenEPSaundersMPBootH, et al. Prospective study on late renal toxicity following postoperative chemoradiotherapy in gastric cancer. Int J Radiat Oncol Biol Phys2007; 67: 781–785.
12.
VermaVBhirudARDennistonKA, et al. Quantification of renal function following stereotactic body radiotherapy for pancreatic cancer: secondary dosimetric analysis of a prospective clinical trial. Radiat Oncol2017; 12(1): 71.
13.
KratochwilCBruchertseiferFRathkeH, et al. Targeted α-therapy of metastatic castration-resistant prostate cancer with 225Ac-PSMA-617: dosimetry estimate and empiric dose finding. J Nucl Med2017; 58: 1624–1631.
14.
StaabGTegtmeyerCConstableW. Radiation-induced renovascular hypertension. Am J Roentgenol1976; 126: 634–637.
15.
ShapiroAPCavalloTCooperW, et al. Hypertension in radiation nephritis: report of a patient with unilateral disease, elevated renin activity levels and reversal after unilateral nephrectomy. Arch Intern Med1977; 137: 848–851.
16.
MoulJW. Retroperitoneal fibrosis following radiotherapy for stage I testicular seminoma. J Urol1992; 147: 124–126.
17.
DhakalBSingaviACohenEP, et al. Chronic GVHD and concurrent new-onset nephrotic syndrome in allogeneic transplant recipients. Incidence, pattern, and therapeutic outcomes. Bone Marrow Transplant2015; 50: 449–451.
18.
CohenEPFareseAMParkerGA, et al. Lack of cellular inflammation in a non-human primate model of radiation nephropathy. Health Phys2020; 119: 588–593.
19.
CohenEP. Fibrosis causes progressive kidney failure. Med Hypotheses1995; 45: 459–462.
20.
MoulderJEFishBL. Late toxicity of total body irradiation with bone marrow transplantation in a rat model. Int J Radiat Oncol Biol Phys1989; 16: 1501–1509.
21.
UnthankJLMillerSJQuickeryAK, et al. Delayed effects of acute radiation exposure in a murine model of the H-ARS: multiple-organ injury consequent to <10 gy total body irradiation. Health Phys2015; 109: 511–521.
22.
CohenEPHankeyKGBennettAW, et al. Acute and chronic kidney injury in a non-human primate model of partial-body irradiation with bone marrow sparing. Radiat Res2017; 188: 661–671.
23.
CohenEPFishBLMoulderJE. Treatment of radiation nephropathy with captopril. Radiat Res1992; 132: 346–350.
24.
MoulderJEFishBLCohenEP. Treatment of radiation nephropathy with ACE inhibitors. Int J Radiat Oncol Biol Phys1993; 27: 93–99.
25.
MoulderJECohenEPFishBL. Captopril and losartan for mitigation of renal injury caused by single-dose total-body irradiation. Radiat Res2011; 175: 29–36.
26.
CohenEPMoulderJEFishBL, et al. Prophylaxis of experimental bone marrow transplant nephropathy. J Lab Clin Med1994; 124: 371–380.
27.
KimJHBrownSLKolozsvaryA, et al. Modification of radiation injury by ramipril, inhibitor of angiotensin-converting enzyme, on optic neuropathy in the rat. Radiat Res2004; 161: 137–142.
28.
GaoFFishBLMoulderJE, et al. Enalapril mitigates radiation-induced pneumonitis and pulmonary fibrosis if started 35 days after whole-thorax irradiation. Radiat Res2013; 180: 546–552.
29.
CohenEPFishBLMoulderJE. The renin-angiotensin system in experimental radiation nephropathy. J Lab Clin Med2002; 139: 251–257.
30.
CohenSRCohenEP. Chronic oxidative stress after irradiation: an unproven hypothesis. Med Hypotheses2013; 80: 172–175.
31.
MusioF. Revisiting the treatment of anemia in the setting of chronic kidney disease, hematologic malignancies, and cancer: perspectives with opinion and commentary. Expert Rev Hematol2020; 13(11): 1175–1188.
32.
de Brito-AshurstIVaragunamMRafteryMJ, et al. Bicarbonate supplementation slows progression of CKD and improves nutritional status. J Am Soc Nephrol2009; 20: 2075–2084.
33.
GorayaNWessonDE. Clinical evidence that treatment of metabolic acidosis slows the progression of chronic kidney disease. Curr Opin Nephrol Hypertens2019; 28: 267–277.
34.
CohenEPBediMIrvingAA, et al. Mitigation of late renal and pulmonary injury after hematopoietic stem cell transplantation. Int J Radiat Oncol Biol Phys2012; 83: 292–296.
35.
United States Renal Data System. 2020 USRDS annual data report: epidemiology of kidney disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2020.
36.
ButcherJAHariharanSAdamsMB, et al. Renal transplantation for end-stage renal disease following bone marrow transplantation: a report of six cases, with and without immunosuppression. Clin Transplant1999; 13: 330–335.
MclaughlinPDJonesBMaherMM. An update on radioactive release and exposures after the Fukushima Dai-ichi nuclear disaster. Br J Radiol2012; 85: 1222–1225.
