title: Radiation injury in the human kidney: a prospective analysis using specific scintigraphic and biochemical endpoints.
abstract: Renal function was prospectively analyzed in 26 evaluable patients, irradiated to various doses on their kidneys for neoplastic disease. Glomerular function was assessed by 99mTc-DTPA renography, creatinine clearance, and serum beta 2-microglobulin, whereas tubular function was monitored by 99mTc-DMSA scintigraphy, urine beta 2-microglobulin, urine N-acetyl glucosaminidase, and alanine aminopeptidase and a urine concentration test. In the patients given the highest irradiation dose to the entire left kidney, that is, 40 Gy in 5 1/2 weeks, glomerular and tubular functional impairment, as assessed scintigraphically, progressed at a rate of 2.0 +/- 1.0% (+/- 1 SD) and 2.0 +/- 0.5% per month, respectively, down to 30-40% after 3 to 5 years. The overall glomerular function, as assessed by creatinine clearance, decreased by only 20%. In the patients irradiated unilaterally on the upper pole to 40 Gy in 4 weeks, glomerular and tubular function in the left kidney deteriorated at 0.75 +/- 0.33% and 0.75 +/- 0.20% per month in the first 2 years, down to 75-80% at 5 years. This smaller reduction was due to shielding of a part of the left kidney. No changes were observed, thus far, after bilateral whole kidney irradiation to 17-18 Gy in 3 1/2 weeks. The concentration capacity of the kidney after total volume irradiation was not impaired. There was a trend for an increase in diastolic blood pressure in 3 out of 5 patients given the high dose irradiation to the entire left kidney and in 2 out of 7 patients irradiated on the upper pole of the left kidney. The progressive nature of the radiation nephropathy stresses the need for long term follow-up to determine more accurately the "tolerance dose" of the human kidney for irradiation.
authors.affiliation: Department of Radiotherapy, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Huis, Amsterdam.
authors.forename: L
authors.initials: L
authors.lastname: Dewit
authors.forename: J K
authors.initials: JK
authors.lastname: Anninga
authors.forename: C A
authors.initials: CA
authors.lastname: Hoefnagel
authors.forename: W J
authors.initials: WJ
authors.lastname: Nooijen
mesh_terms: D000118:Acetylglucosaminidase / Q000652:urine; D000626:Aminopeptidases / Q000652:urine; D018826:CD13 Antigens; D003404:Creatinine / Q000652:urine; D005260:Female; D006801:Humans; D007668:Kidney / Q000528:radiation effects*; D008297:Male; D015609:Organotechnetium Compounds; D011446:Prospective Studies; D011832:Radiation Injuries / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D011866:Radioisotope Renography; D011878:Radiotherapy / Q000009:adverse effects*; D004113:Succimer; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D016284:Technetium Tc 99m Pentetate; D001613:beta 2-Microglobulin / Q000032:analysis / Q000652:urine
chemical_list: D015609:Organotechnetium Compounds; D001613:beta 2-Microglobulin; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D003404:Creatinine; D004113:Succimer; D000118:Acetylglucosaminidase; D000626:Aminopeptidases; D018826:CD13 Antigens; D016284:Technetium Tc 99m Pentetate