RADIATION NEPHRITIS: A CLINICOPATHOLOGIC STUDY
Clinical and pathologic findings are correlated in five cases of radiation nephritis in an attempt to establish a new approach to the pathologic criteria for diagnosis, relating not only to clinical course but also to prognosis by use of the percutaneous renal biopsy technic. The investigation showed that in some cases certain elements of the kidney may be affected more severely than others, and that the main clinical findings depend upon which one of these elements is principally affected, i.e., glomerulus, the tubule, or interstitial tissue. The results showed that Luxton's classification of clinical and morphologic criteria of radiation nephritis require modification. Although the majority of clinical cases of radiation nephritis can be classified according to his four types, there remain cases which pass through several clinical phases in their evolution. In one case hypertension developed following radiation, which was relieved by nephrectomy. The hypertension was apparently due to arteritis deformaties of the interlobar arteries with marked narrowing of the lumen. Two other patients showed signs and symptoms of acute radiation nephritis; however, in one the clinical picture of benign hypertension developed later and in the other mild chronic radiation nephritis developed. It is recommended that diagnosis of radiation nephritis be based on five criteria: a history of irradiation, glomerular changes, tubular and parenchymal changes, renal capsular fibrosis, and vascuiar changes. In glomerular changes, the most important feature was the presence of diffuse involvement of the glomeruli. Marked interstitial fibrosis of the cortex, with atropy and disappearance of the tubules combined with focal regeneration of tubular lining cells, is very suggestive of radiation nephritis. Vascular changes which appeared to be important were the marked involvement of the glomerular capillaries, and of arterioles and small arteries, including interlobular and intralobular arteries. Lipid deposits in glomeruli and small blood vessels, together with fibrinoid necrosis, when present, were suggestive of radiation damage. The results of renal biopsy showed that this method is a useful adjunct in the diagnostic and prognostic assessment of radiation nephritis. (BBB)
- Research Organization:
- Veterans Administration Hospital, Philadelphia
- NSA Number:
- NSA-17-038763
- OSTI ID:
- 4657630
- Journal Information:
- American Journal of Medicine (U.S.), Vol. Vol: 33; Other Information: Orig. Receipt Date: 31-DEC-63
- Country of Publication:
- Country unknown/Code not available
- Language:
- English
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