Radiation-induced multi-organ involvement and failure: the contribution of radiation effects on the renal system

Clinical and experimental studies suggest that acute or chronic renal injury could occur after certain types of radiation accidents. Such renal injury could be life-threatening in its own right, could exacerbate other radiation injuries and could complicate the treatment of non-radiation injuries. The clinical experience with therapeutic bone marrow transplantation (BMT) indicates that acute renal failure is conceivable in radiation accident victims who receive BMT, and there are experimental data that suggest that radiation-induced bone marrow aplasia could exacerbate acute renal failure caused by other agents. Both the experimental data and the clinical experience with therapeutic BMT also suggest that chronic renal failure could occur after radiation accidents if the bilateral renal dose exceeded 4–5 Gy and if bone marrow toxicity was avoided by partial body shielding or therapeutic interventions. In addition, clinical experience using radiolabelled biologicals in cancer therapy shows that internal deposition of certain types of radioactive material can cause chronic renal failure. There is clinical evidence that the progression of established chronic radiation-induced renal injury can be attenuated by treatment with angiotensin converting enzyme (ACE) inhibitors or angiotensin II (AII) receptor antagonists. There is also pre-clinical evidence that the risk of radiation-induced chronic renal failure can be reduced through prophylactic use of ACE inhibitors or AII receptor antagonists, and a randomised clinical trial of this approach is in progress.