Radiation-associated kidney injury.
The kidneys are the dose-limiting organs for radiotherapy to upper abdominal cancers and during total body irradiation. The incidence of radiotherapy-associated kidney injury is likely underreported owing to its long latency and because the toxicity is often attributed to more common causes of kidney injury. The pathophysiology of radiation injury is poorly understood. Its presentation can be acute and irreversible or subtle, with a gradual progressive dysfunction over years. A variety of dose and volume parameters have been associated with renal toxicity and are reviewed to provide treatment guidelines. The available predictive models are suboptimal and require validation. Mitigation of radiation nephropathy with angiotensin-converting enzyme inhibitors and other compounds has been shown in animal models and, more recently, in patients.
Dawson
Laura A
LA
Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada. laura.dawson@rmp.uhn.on.ca
Kavanagh
Brian D
BD
Paulino
Arnold C
AC
Das
Shiva K
SK
Miften
Moyed
M
Li
X Allen
XA
Pan
Charlie
C
Ten Haken
Randall K
RK
Schultheiss
Timothy E
TE
D000818:Animals; D004307:Dose-Response Relationship, Radiation; D005544:Forecasting; D006801:Humans; D007668:Kidney / Q000528:radiation effects*; D023421:Models, Animal; D011832:Radiation Injuries / Q000150:complications* / Q000503:physiopathology; D011836:Radiation Tolerance; D014916:Whole-Body Irradiation / Q000009:adverse effects