Radiation-associated Kidney Injury

Radiation-associated kidney injury, also known as radiation nephropathy, can occur in both the acute and chronic phase, but most commonly occurs 6–12 months after exposure. It is difficult to predict who is at risk for radiation nephropathy because of the varying doses, dosing fractionation and other systemic treatments cancer patients receive. Patients typically present with hypertension, edema and proteinuria consistent with an acute kidney injury but can also be accompanied by microangiopathic hemolytic anemia with schistocytes and thrombocytopenia. Renal biopsy findings are not specific to radiation injury and are more typical of HUS. Progression to chronic renal failure and ultimately to dialysis dependence is common. ACE inhibitors and ARBs are increasingly being used as successful treatment. The development of end stage renal disease is a poor prognostic event in these patients and survival on chronic dialysis is poor compared to that of age-matched non-diabetic and diabetic patients.