Radiation-Induced Stenosis of the Renal Artery Causing Hypertension: Case Report

Gerlock, Amil J.; Goncharenko, Victor; Ekelund, Leif

doi:10.1016/s0022-5347(17)58299-3

Cited by 25 publications

(6 citation statements)

References 13 publications

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“…We observed that hypertension was more prevalent among survivors of nonsyndromic, unilateral WT treated with nephrectomy, regardless of radiation status, suggesting that nephrectomy contributes to its pathogenesis. Posttreatment hypertension has been reported previously following abdominal irradiation for WT, 24 including among patients found to have post‐irradiation renal artery stenosis 25‐27 . One large series identified diastolic hypertension at the fifth anniversary after diagnosis of WT among 7% (39/561) of males and 7% (44/610) of females 28 .…”

Section: Discussionmentioning

confidence: 86%

“…Posttreatment hypertension has been reported previously following abdominal irradiation for WT, 24 including among patients found to have post-irradiation renal artery stenosis. [25][26][27] One large series identified diastolic hypertension at the fifth anniversary after diagnosis of WT among 7% (39/561) of males and 7% (44/610) of females. 28 The hazard ratio for hypertension was The results of this study must be interpreted taking into consideration the limitations related to the small sample size and the study design, which was a nonrandomized sample of the eligible unirradiated and irradiated patients.…”

Section: Discussionmentioning

confidence: 99%

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Long‐term renal function after treatment for unilateral, nonsyndromic Wilms tumor. A report from the St. Jude Lifetime Cohort Study

Green

Wang

Krasin

et al. 2020

Pediatric Blood & Cancer

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Background The impact of specific treatment modalities on long‐term renal function and blood pressure among adult survivors of Wilms tumor (WT) has not been well documented. Methods Among 40 WT survivors and 35 noncancer controls, we estimated the glomerular filtration rate (eGFR) using the Chronic Kidney Disease‐Epidemiology (CKD‐EPI) equations with and without cystatin C, obtained 24‐hour ambulatory blood pressure readings, and, among survivors only, measured 99mTc diethylenetriamine pentaacetic acid (DTPA) plasma clearance. Survivors were treated with unilateral nephrectomy and nonnephrotoxic chemotherapy. Twenty received whole abdomen radiation therapy (WART) [median –16.5 Gray (Gy)], and 20 received no radiation therapy. Pairwise comparisons between survivors treated with and without WART, and each group to controls were performed using two‐sample t tests. Results Twenty‐six (65%) WT survivors were female, and 33 (83%) were non‐Hispanic white. GFR estimated with creatinine or creatinine + cystatin C was decreased among irradiated survivors compared with controls. No irradiated or unirradiated participant had an eGFR (creatinine + cystatin C) < 60 mL/min/1.73 m2. The prevalence of hypertension was significantly increased among unirradiated (25%) and irradiated survivors (35%) compared with controls (0%). Of the 24‐hour ambulatory blood pressure monitoring parameters evaluated, only mean sleep period diastolic blood pressure load of those who received WART was significantly different from that of controls. Conclusions Chronic kidney disease was infrequent in long‐term survivors of unilateral nonsyndromic WT, whether treated with WART or no radiation. The prevalence of hypertension was increased in both groups compared with controls, emphasizing the need for ongoing monitoring of renal and cardiovascular health.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Long‐term renal function after treatment for unilateral, nonsyndromic Wilms tumor. A report from the St. Jude Lifetime Cohort Study

Green

Wang

Krasin

et al. 2020

Pediatric Blood & Cancer

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“…Additional cases of renovascular hypertension associated with abdominal radiotherapy and documented renal artery stenosis have been presented by McGiLl [73], Staab [74], Stanley et a1 [75], and Gerlock [76]. A total of 12 cases are summarized in Tables II and III.…”

Section: Radiation-induced Coronary Artery Diseasementioning

confidence: 98%

Radiation‐induced chronic arterial injury

Himmel

Hassett

1986

Seminars in Surgical Oncology

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Acute arterial disruption associated with infection, previous irradiation, and the postoperative state is a well-described entity. The recognition of a chronic form of radiation-induced arterial injury presenting years after therapeutic doses of radiation is less well appreciated. This paper summarizes the vital data obtained by reviewing the literature concerning 162 cases of arterial injury associated with prior radiotherapy. The vessels involved include coronary arteries, the aorta, renal arteries, the extra- and intracranial circulation, the ilio-femoral system, and the upper extremity arteries. A review of the histologic findings, the studies regarding pathogenesis, and the morphology of the lesions found in these 162 patients suggests a disease distinct from the atherosclerotic process.

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“…der Tunica muscularis media durch Kollagen beschrieben. Selten erwähnte Patho- [2,7,11,16,[23][24][25]30]. Dies kann auf einen diagnostischen Bias zurückzuführen sein.…”

Section: Diskussionunclassified

“…Vincristin kann Hypertonie verursachen[31]. Elf[9,11,15,18,20,26,27] der bisher 21 Patienten (Tabelle 1) mit radiogen induzierter Nierenarterienstenose wurden mit Chemotherapie behandelt, lediglich bei vier Patienten[15,20,26,27] wurden die Chemotherapieregime näher bezeichnet. In drei Fallberichten[5,19,34] finden sich keine Angaben zu einer allfälligen Chemotherapie.…”

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Radiotherapieinduzierte Nierenarterienstenose nach Behandlung eines Ewing-Sarkoms

Tacconi

Bieri

2008

Strahlenther Onkol

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Radiation-induced renal artery stenosis has only rarely been described in the literature, but arterial hypertension due to radiation-induced renal artery stenosis is a serious long-term sequela that can appear at a latency of up to 20 years after treatment. The paucity of reports presumably reflects the lesser frequency of radiotherapy for retroperitoneal tumors as compared to head-and-neck cancers, as well as lower awareness of the problem due to diagnostic bias in the era before CT and MRI were in routine use: at that time, carotid artery stenosis was easy to diagnose by ultrasonography, while radiation-induced renal artery stenosis, whose real incidence may well be higher, probably often went undetected. Thus, when a patient with a history of abdominal or retroperitoneal radiotherapy unexpectedly develops intractable hypertension, radiation-induced renal artery stenosis must be included in the differential diagnosis.

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Radiation-Induced Stenosis of the Renal Artery Causing Hypertension: Case Report

Abstract: A case is presented of renal artery stenosis causing renin-dependent hypertension 11 1/2 years after irradiation for Wilms tumor. The literature was reviewed briefly for other cases of large artery damage after irradiation therapy.

Cited by 25 publications

References 13 publications

Long‐term renal function after treatment for unilateral, nonsyndromic Wilms tumor. A report from the St. Jude Lifetime Cohort Study

Long‐term renal function after treatment for unilateral, nonsyndromic Wilms tumor. A report from the St. Jude Lifetime Cohort Study

Radiation‐induced chronic arterial injury

Radiotherapieinduzierte Nierenarterienstenose nach Behandlung eines Ewing-Sarkoms

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