Understanding irradiation damage and effects in α-uranium (α-U) is critical to modeling the behavior of U-based metallic fuels. The aim of this review is to address the renewed interest in U-based metallic fuels by examining the state-of-the-art knowledge associated with the effect of irradiation on the microstructure, dimensional changes, and properties of α-U. We critically review the research progress on irradiation-induced growth and swelling, the enhancement of plastic flow and superplasticity by irradiation, and the effect of irradiation on thermal and electrical properties of α-U. Finally, we outline the research directions that require advancements, specifically the need to carry out fundamental research on several of the less understood mechanisms of irradiation damage and effects in α-U.