Radiation-induced kidney injury

Abstract

Renal dysfunction because of radiation exposure was recognized decades ago. The incidence declined when more effective chemotherapeutic agents became available. However, there appears to be a resurgence with the advent of total body irradiation used prior to hematopoietic stem cell transplantation. Several chemotherapeutic drugs used prior to total body irradiation have some ionizing radiation potentiating effects. Chronic kidney disease that occurs after hematopoietic stem cell transplantation is known to occur due to nephrotoxicity from medications, graft-versus-host disease, and the currently under-recognized radiation exposure. The clinical features vary depending on the dose of radiation and the volume of single or bilateral kidneys exposed. The usual symptoms of fatigue, edema, anemia, malignant hypertension, azotemia, and shortness of breath appear in 6–12 months of exposure. Since this is an under-recognized entity, there are no large controlled trials to guide therapy. This review highlights some of the experimental data that have shown some promising results for treatment. There is need for further studies on the current incidence and prevalence and clinical trials to guide treatment, based on the experimental data available.

Renal lymphomatous infiltration by mantle cell lymphoma: Treatment with chemoradiation and initiation of angiotensin converting enzyme (ACE) inhibitor for renal protection

“…Single fraction radiation doses as low as 4 Gy may lead to renal injury, and a prior study found that radiation nephropathy was found in 20% of irradiated subjects. 4 The absence of any signs or symptoms of kidney injury at the time of re-treatment should not be considered as absence of latent or residual injury. Doses of radiation may sometimes be too low to produce overt damage but do significantly reduce the tolerance to re-treatment.…”

“…Underlying CKD due to hypertension or diabetes, liver diseases, heart disease, and smoking can also reduce the tolerance to RT. 4 However, the impact of these variables is not well recognized. There is great uncertainty among the dose-volume recommendations since only a few studies are based on long term follow ups.…”

Involvement of Klotho, TNF‑α and ADAMs in radiation‑induced senescence of renal epithelial cells

“…Critically, some types of soluble Klotho may exist in the blood, urine and other body fluids, where it performs a multitude of functions in renal inflammatory response. However these pleiotropic roles are poorly understood (8,(41)(42)(43). Moreover, the differences between BALB/c and C57BL/6 mice with regards to changes in TNF-α and ADAM9/10/17 expression caused by irradiation may be assessed in future research.…”

Rational Design of Nanomaterials for Various Radiation‐Induced Diseases Prevention and Treatment

“…[ 161 ] Clinical symptoms include edema, fatigue, malignant hypertension, anemia, azotemia, and breath shortness. [ 162,163 ] Regarding the injury mechanisms and as a paradigm, Balabanli et al. studied the role of free radicals in the radiation nephropathy mechanism.…”

“…reviewed the pathophysiological changes in irradiated kidneys, including glomerular changes, tubulo‐interstitial injury, vascular injury, and functional changes. [ 163 ] Adhikari et al. had already achieved nanomaterial‐mediated kidney radiation disease treatment at the cellular level, in 2015.…”