Kidney nontumor
Miscellaneous
Radiation nephropathy

Author: Nikhil Sangle, M.D. (see Authors page)

Revised: 23 March 2018, last major update December 2012

Copyright: (c) 2003-2017, PathologyOutlines.com, Inc.

PubMed Search: Radiation nephropathy [title]

Cite this page: Sangle, N. Radiation nephropathy. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/kidneyradiationnephropathy.html. Accessed August 17th, 2018.
Definition / general
  • 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
  • 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
Microscopic (histologic) description
  • 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
Microscopic (histologic) 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

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
  • Focal IgM and fibrinogen
Electron microscopy description
  • 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