Radiation nephropathy

Radiation nephropathy can present in several forms. An acute form is usually seen within a year after radiation and presents with hypertension, anemia and edema. A more insidious chronic form presents primarily with diminished glomerular filtration, hypertension and occasionally proteinuria. When present, associated accelerated hypertension can promote renal failure. Some patients may develop hypertension within several years after radiation but no azotemia. In a subset of patients, mild proteinuria may be the only feature of chronic renal disease [235]. 

Morphologic studies of radiation nephropathy have documented injury to blood vessels, glomeruh, tubular epithelium and interstitium. Recent ultrastructural studies indicate that glomerular endothelium is an early site of visible injury [236] with endothehal disruption and leukocyte adherence. Later, tubular degeneration and atrophy occur. The second pathophysiologic hypothesis holds vascular injury as the main initial event [237] which helps understand the hypertension occurring in radiation nephritis but does not account for the glomerular lesions. 

Even though radiation nephropathy has been known for a long time, first therapeutic attempts were only made recently when it has been documented... 

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Cohen EP, Fish BL, Moulder JE Treatment of radiation nephropathy with captoprll. Radlat Res. 1992,132 346-350. 

Cassidy JR. Clinical radiation nephropathy. Int J Radiat Oncol Biol Phys 1995 31 1249-1256. 

Radiation nephropathy can present in several forms. An acute form is usually seen within a year af-... 

Burdelya LG, Krivokrysenko VI, Tallant TC et al. (2008) An agonist of toll-like receptor 5 has radioprotective activity in mouse and primate models. Science 320 226 230 Chen L, Brizel DM, Rabbani ZN et al. (2004) The protective effect of recombinant human keratinocyte growth factor on radiation-induced pulmonary toxicity in rats. Int J Radiat Oncol Biol Phys 60 1520-1529 Cohen EP, Fish BL, and Moulder JE (1997) Successful brief captopril treatment in experimental radiation nephropathy. J Lab Clin Med 129 536-547... 

Moulder JE, Fish BL, Cohen EP (1998a) Radiation nephropathy is treatable with an angiotensin converting enzyme inhibitor or an angiotensin II type-1 (ATI) receptor antagonist. Radiother Oncol 46 307-315... 

Moulder JE, Fish BL, Cohen EP (1998b) Angiotensin II receptor antagonists in the treatment and prevention of radiation nephropathy. Int J Radiat Biol 73 415-421... 

Moulder JE, Fish BL, Cohen EP (2007b) Treatment of radiation nephropathy with ACE inhibitors and All type-1 and type-2 receptor antagonists. Curr Pharm Des 13 1317-1325... 

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