Radiation Nephritis

Luxton, R.W.

doi:10.1016/s0140-6736(61)92590-9

Cited by 113 publications

(34 citation statements)

References 2 publications

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“…32 This patient also displayed an increased serum creatinine and hypertension 9 years after BMT, a latency period possibly analogous to that for classic chronic radiation nephropathy as described by Luxton and Kunkler. 33 If, then, TBI is the most probable cause of renal impairment in our patients, it remains to be explained why only seven out of 26 patients developed renal impairment in the +TBI group, when all patients had received the same treatment and the baseline characteristics were very similar. The only apparent difference was that the patients in the renal impairment group had received more nephrotoxic antibiotics (a combination of vancomycin and aminoglycoside) during the early posttransplant period.…”

Section: Discussionmentioning

confidence: 77%

“…[14][15][16] The clinical, laboratory and histopathological presentations of BMT Np, which is reminiscent of acute radiation nephritis as originally described by Luxton and co-workers, points to conditioning TBI as the major cause of this syndrome. 18,33 However, Luxton identified the renal tolerance dose as being about 20 Gy -a higher dose than that used in BMT today. One explanation for this discrepancy may be that Luxton used longer interfractionation intervals, allowing radiation damage to repair between fractions.…”

Section: Discussionmentioning

confidence: 99%

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Renal function after autologous bone marrow transplantation in children: a long-term prospective study

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Bratteby

Carlson

et al. 2002

Bone Marrow Transplant

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Summary:We measured glomerular filtration rate (GFR), effective renal plasma flow (ERPF) and the concentrating capacity of the kidneys in children after autologous BMT. Twenty-six patients had received TBI in their conditioning regimen and 14 patients had received chemotherapy only. Median follow-up was 10 years. Mean After this initial decrease, GFR and ERPF remained essentially unchanged in both groups. The mean concentrating capacity of the kidneys was normal before and after BMT. In seven patients chronic renal impairment developed after BMT (GFR Ͻ70 ml/min/1.73 m 2 ). All had received TBI. They had also received more nephrotoxic antibiotics than the other patients. We conclude that TBI was the principal cause of deterioration of renal function after BMT, possibly by limiting compensatory hyperperfusion and resulting in a fall in GFR. Antibiotic treatment may have contributed.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Renal function after autologous bone marrow transplantation in children: a long-term prospective study

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Bratteby

Carlson

et al. 2002

Bone Marrow Transplant

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“…The clinical types of radiation nephritis have been separated into five categories (70)(71)(72): acute radiation nephritis; chronic radiation nephritis; asymptomatic proteinuria; benign essential hypertension; and late malignant hypertension. Acute radiation nephritis is associated with a variable degree of proteinuria with hypertension and uremia and may occur prior to or without the development of other symptoms.…”

Section: Tubular and Interstitial Diseasementioning

confidence: 99%

Renal response to environmental toxics

Finn¹

1977

Environ Health Perspect

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Several characteristics of normal renal function increase the risk to the kidney of damage by environmental toxins. Due to the magnitude of renal blood flow the total amount of noxious substance delivered may be disproportionately high. Furthermore, the capacity to concentrate substances within the kidney by processes of filtration, reabsorption and secretion has the potential to increase the toxicity of agents which would otherwise not lead to tissue injury. Unfortunately, there are few tests of renal function which are able to detect early functional abnormalities and which, at the same time, are suited for screening purposes by virtue of their simplicity, cost and safety. Furthermore, interpretation of the tests is complicated by adaptive changes in renal function which occur with aging and in response to other disease processes. Environmental agents produce a wide spectrum of renal dysfunction. Acute renal damage follows exposure to glycols, organic solvents, heavy metals, diagnostic and therapeutic agents and a variety of miscellaneous substances. Chronic renal disease may take the form of isolated tubular defects as seen with cadmium, interstitial nephritis due to the ingestion of lead, or vascular damage induced by external radiation. Some forms of glomerulonephritis may also be related to environmental toxins as are certain tumors of the urinary tract. In a somewhat different fashion, patients whose renal function is limited by the presence of pre-existing disease may manifest toxicity from substances ordinarily excreted in the urine. Particular problems exist with the patients on dialysis, as they are at considerable risk to alterations in the environment.

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“…Radiobiologic data for kidney tolerance in animals and humans are well established for specified irradiation volumes, fractionation schemes, and dose rates (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Mohan et al (25), Burman et al (26), Lyman (27), and, specifically for kidney, Olsen et al (28) and Yorke et al (29) found it useful to provide a dose-volume histogram analysis to predict the normal-tissue complication probabilities when organs receive partial or nonuniform irradiation during conformal external-beam radiotherapy or brachytherapy irradiation near critical normal structures.…”

mentioning

confidence: 99%

MIRD Pamphlet No. 20: The Effect of Model Assumptions on Kidney Dosimetry and Response—Implications for Radionuclide Therapy

Wessels¹,

Konijnenberg²,

Dale³

et al. 2008

J Nucl Med

164

114

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Renal toxicity associated with small-molecule radionuclide therapy has been shown to be dose-limiting for many clinical studies. Strategies for maximizing dose to the target tissues while sparing normal critical organs based on absorbed dose and biologic response parameters are commonly used in external-beam therapy. However, radiopharmaceuticals passing though the kidneys result in a differential dose rate to suborgan elements, presenting a significant challenge in assessing an accurate dose-response relationship that is predictive of toxicity in future patients. We have modeled the multiregional internal dosimetry of the kidneys combined with the biologic response parameters based on experience with brachytherapy and external-beam radiation therapy to provide an approach for predicting radiation toxicity to the kidneys. Methods: The multiregion kidney dosimetry model of MIRD pamphlet no. 19 has been used to calculate absorbed dose to regional structures based on preclinical and clinical data. Using the linear quadratic model for radiobiologic response, we computed regionally based surviving fractions for the kidney cortex and medulla in terms of their concentration ratios for several examples of radiopharmaceutical uptake and clearance. We used past experience to illustrate the relationship between absorbed dose and calculated biologically effective dose (BED) with radionuclide-induced nephrotoxicity. Results: Parametric analysis for the examples showed that high dose rates associated with regions of high activity concentration resulted in the greatest decrease in tissue survival. Higher dose rates from short-lived radionuclides or increased localization of radiopharmaceuticals in radiosensitive kidney subregions can potentially lead to greater whole-organ toxicity. This finding is consistent with reports of kidney toxicity associated with early peptide receptor radionuclide therapy and 166 Ho-phosphonate clinical investigations. Conclusion: Radionuclide therapy doseresponse data, when expressed in terms of biologically effective dose, have been found to be consistent with external-beam experience for predicting kidney toxicity. Model predictions using both the multiregion kidney and linear quadratic models may serve to guide the investigator in planning and optimizing future clinical trials of radionuclide therapy.

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Radiation Nephritis

Cited by 113 publications

References 2 publications

Renal function after autologous bone marrow transplantation in children: a long-term prospective study

Renal function after autologous bone marrow transplantation in children: a long-term prospective study

Renal response to environmental toxics

MIRD Pamphlet No. 20: The Effect of Model Assumptions on Kidney Dosimetry and Response—Implications for Radionuclide Therapy

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