Hyperreninemic hypertension secondary to radiation nephritis in a child

Pharmacological Interventions for the Prevention and Treatment of Kidney Injury Induced by Radiotherapy: Molecular Mechanisms and Clinical Perspectives

More than half of cancer patients need radiotherapy during the course of their treatment. Despite the beneficial aspects, the destructive effects of radiation beams on normal tissues lead to oxidative stress, inflammation, and cell injury. Kidneys are affected during radiotherapy of abdominal malignancies. Radiation nephropathy eventually leads to the release of factors triggering systemic inflammation. Currently, there is no proven prophylactic or therapeutic intervention for the management of radiation-induced nephropathy. This article reviews the biomarkers involved in the pathophysiology of radiation-induced nephropathy and its underlying molecular mechanisms. The efficacy of compounds with potential radio-protective properties on amelioration of inflammation and oxidative stress is also discussed. By outlining the approaches for preventing and treating this critical side effect, we evaluate the potential treatment of radiation-induced nephropathy. Available preclinical and clinical studies on these compounds are also scrutinized.

[Late effects of radiations on the kidney]

Clinical radiation damage to the kidney are nowadays a rare event. Nevertheless, this organ is very sensitive to radiation and dose exceeding 15 Gy may induce severe and life threatening damage many years after the treatment. Prevention remains the best treatment through a precise localisation of the kidneys before any irradiation of the upper abdomen.

Clinical radiation nephropathy

An analysis of the normal tissue effects of irradiation of the kidney is presented. Various clinical syndromes resulting from treatment are described as well as the potential cellular basis for these findings. Effects of concurrent and/or sequential treatment with irradiation and various chemotherapeutic agents are discussed and the impact of these agents on toxicity presented. Adverse consequences of renal treatment in the child is described and possible radiation effects on so-called compensatory hypertrophy following nephrectomy presented. Renal consequences described to date of bone marrow transplantation programs utilizing irradiation are also presented. The necessity of a dose-volume histogram analysis approach to analyzing renal toxic effects in patients followed for long (> 10 year) periods is essential in developing accurate guidelines of renal tolerance.

Effects of treatment for childhood cancer on vital organ systems

Advances in treatment have dramatically increased the survival rate of children and adolescents with cancer. These treatments, however, may be associated with damage to vital organ systems, which may not be evident until many years after the initial diagnosis of cancer and may adversely affect long-term survival and/or the quality of life of former patients. The effects of treatment on three specific organ systems, heart, lungs, and kidneys, are reviewed here.