Radiation Nephropathy Differential Diagnoses

  • Author: Eric P Cohen, MD; Chief Editor: Vecihi Batuman, MD, FACP, FASN   more...
 
Updated: Jul 6, 2011
 
 

Diagnostic Considerations

Conditions to consider in the differential diagnosis of radiation nephropathy, along with those in the next section, include the following:

  • Cyclosporine or tacrolimus toxicity
  • Pamidronate-induced focal glomerulosclerosis
  • Nephrotic syndrome associated with graft versus host disease
  • Polyoma virus nephropathy

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Eric P Cohen, MD  Professor, Department of Medicine, Division of Nephrology, Medical College of Wisconsin; Nephrology Section Chief, Zablocki Veterans Affairs Hospital

Eric P Cohen, MD is a member of the following medical societies: American Society of Nephrology, Central Society for Clinical Research, International Society of Nephrology, and Radiation Research Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Laura Lyngby Mulloy, DO, FACP  Professor of Medicine, Chief, Section of Nephrology, Hypertension, and Transplantation Medicine, Glover/Mealing Eminent Scholar Chair in Immunology, Medical College of Georgia

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ajay K Singh, MB, MRCP, MBA  Associate Professor of Medicine, Harvard Medical School; Director of Dialysis, Renal Division, Brigham and Women's Hospital; Director, Brigham/Falkner Dialysis Unit, Faulkner Hospital

Disclosure: Nothing to disclose.

Chief Editor

Vecihi Batuman, MD, FACP, FASN  Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, Southeast Louisiana Veterans Health Care System

Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, and International Society of Nephrology

Disclosure: Nothing to disclose.

References

  1. Luxton RW. Radiation nephritis. A long-term study of 54 patients. Lancet. Dec 2 1961;2:1221-4. [Medline].

  2. Cohen EP. Radiation nephropathy after bone marrow transplantation. Kidney Int. Aug 2000;58(2):903-18. [Medline].

  3. Cohen EP, Moulder JE, Robbins ME. Radiation nephropathy caused by yttrium 90. Lancet. Sep 29 2001;358(9287):1102-3. [Medline].

  4. Cohen EP, Robbins ME. Radiation nephropathy. Semin Nephrol. Sep 2003;23(5):486-99. [Medline].

  5. Moll S, Nickeleit V, Mueller-Brand J, et al. A new cause of renal thrombotic microangiopathy: yttrium 90-DOTATOC internal radiotherapy. Am J Kidney Dis. Apr 2001;37(4):847-51. [Medline].

  6. Giralt S, Bensinger W, Goodman M, et al. 166Ho-DOTMP plus melphalan followed by peripheral blood stem cell transplantation in patients with multiple myeloma: results of two phase 1/2 trials. Blood. Oct 1 2003;102(7):2684-91. [Medline].

  7. Cohen EP, Drobyski WR, Moulder JE. Significant increase in end-stage renal disease after hematopoietic stem cell transplantation. Bone Marrow Transplant. May 2007;39(9):571-2. [Medline].

  8. Akasheh M, Priyanath A, Pello N, et al. Accelerated atherosclerosis in a patient with post-BMT nephropathy. Bone Marrow Transplant. Jan 1999;23(2):199. [Medline].

  9. Cohen EP, Piering WF, Kabler-Babbitt C, Moulder JE. End-stage renal disease (ESRD) after bone marrow transplantation: poor survival compared to other causes of ESRD. Nephron. Aug 1998;79(4):408-12. [Medline].

  10. Bernauer W, Gratwohl A, Keller A, Daicker B. Microvasculopathy in the ocular fundus after bone marrow transplantation. Ann Intern Med. Dec 15 1991;115(12):925-30. [Medline].

  11. Stevens LA, Coresh J, Greene T, et al. Assessing kidney function--measured and estimated glomerular filtration rate. N Engl J Med. Jun 8 2006;354(23):2473-83. [Medline].

  12. Markowitz GS, Appel GB, Fine PL, et al. Collapsing focal segmental glomerulosclerosis following treatment with high-dose pamidronate. J Am Soc Nephrol. Jun 2001;12(6):1164-72. [Medline].

  13. Keane WF, Crosson JT, Staley NA, et al. Radiation-induced renal disease. A clinicopathologic study. Am J Med. Jan 1976;60(1):127-37. [Medline].

  14. Choi KL, Bakris GL. Hypertension treatment guidelines: practical implications. Semin Nephrol. Jul 2005;25(4):198-209. [Medline].

  15. Cohen EP, Hussain S, Moulder JE. Successful treatment of radiation nephropathy with angiotensin II blockade. Int J Radiat Oncol Biol Phys. Jan 1 2003;55(1):190-3. [Medline].

  16. Moulder JE, Fish BL, Cohen EP. Radiation nephropathy is treatable with an angiotensin converting enzyme inhibitor or an angiotensin II type-1 (AT1) receptor antagonist. Radiother Oncol. Mar 1998;46(3):307-15. [Medline].

  17. Cohen EP, Irving AA, Drobyski WR, et al. Captopril to mitigate chronic renal failure after hematopoietic stem cell transplantation: a randomized controlled trial. Int J Radiat Oncol Biol Phys. Apr 1 2008;70(5):1546-51. [Medline].

  18. Sarode R, McFarland JG, Flomenberg N, et al. Therapeutic plasma exchange does not appear to be effective in the management of thrombotic thrombocytopenic purpura/hemolytic uremic syndrome following bone marrow transplantation. Bone Marrow Transplant. Aug 1995;16(2):271-5. [Medline].

 
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Evolution of the glomerular filtration rate (GFR) versus time in a case of nephropathy related to bone marrow transplantation (BMT). GFR may be approximated as 100/plasma creatinine on the Y axis and graphed versus time on the X axis. As is true in many cases of BMT nephropathy, the evolution appears to be biphasic, with an initial rapid decline in GFR, then a slower plateau phase. The patient whose data are shown here ultimately underwent kidney transplantation.
Photomicrograph of a kidney-biopsy sample in a case of nephropathy associated with bone marrow transplantation (periodic acid-Schiff stain). A glomerulus is in the center and is relatively hypocellular. Increased mesangial matrix is present. The glomerular basement membranes are not thickened; in some places, however, they are separated from the capillary lumens by a low-density, matrixlike material. Interstitial fibrosis separates the tubules from each other. Arteriolar thickening and arteriolar hyalin are present.
 
 
 
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