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Kidney non-tumor

Miscellaneous

Radiation nephropathy


Reviewers: Nikhil Sangle, M.D. (see Reviewers page)
Revised: 25 December 2012, last major update September 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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Acute radiation nephropathy: 6-12 months after radiation exposure, may occur quicker in children; gradual onset of edema, hypertension, dyspnea after exertion, pleural and peritoneal serous effusions, anemia, headaches, proteinuria and urinary casts; associated with reduction in glomerular filtration rate and renal failure in 50%; those who recover have persistent proteinuria and renal impairment; overall high mortality rate (eMedicine)
Chronic radiation nephropathy: either follows acute phase or develops insidiously; mild proteinuria and moderate hypertension years after radiation exposure
● Severity is related to dose, method of irradiation, age, amount of perirenal fat, presence of renal disease and use of chemotherapy

Micro description
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● Glomeruli: segmental fibrinoid necrosis, thickened glomerular capillary walls with double contour (silver stain), variable glomerulosclerosis and prominent mesangium
● Tubules: swelling of tubular epithelium with desquamation, basement membrane thickening and splitting, tubular loss and atrophy; often abnormal tubular regeneration; focally scarred interstitium without inflammation
● Vessels: fibrinoid necrosis of arterioles and small arteries with variable thrombosis

Micro images
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Nephropathy associated with bone marrow transplantation (PAS stain); glomerulus is relatively hypocellular, glomerular basement membranes are not thickened; but are separated from capillary lumens focally by a low-density, matrixlike material; increased mesangial matrix is present; interstitial fibrosis separates tubules from each other; arteriolar thickening and arteriolar hyalin are present


Bone marrow transplant related radiation nephropathy


Glomerular basement membrane splitting (arrowhead), mesangial expansion (asterisk), subendothelial accumulation of amorphous material, and focal intracapillary thrombi (arrow); interstitial expansion but only scant inflammatory infiltrates

Immunofluorescence
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● Focal IgM and fibrinogen

Electron microscopy description
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● Widened glomerular subendothelium due to fibrin or flocculent material (Arch Pathol Lab Med 1977;101:469)
● May have focal extension of mesangium into subendothelial space
● Swollen or focally detached endothelium

Electron microscopy images
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Bone marrow transplant related radiation nephropathy

End of Kidney non-tumor > Miscellaneous > Radiation nephropathy

Ref Updated: 9/6/12


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