الفهرس 
EpidemiologyOnly 14 pages are availabe for public view
 |  | from | 3 |  |  |
| | | from | 3 | | |
Abstract
The occurrence of kidney dysfunction following external radiation has been recognized for a hun¬dred years.
The introduction of different dosing reg¬imens for total-body irradiation and local body radiation have raised questions on the tolerance of the kidneys to ra¬diation delivered and development of radiation nephropathy over a shorter period of time.
Radiation nephropathy is a syndrome of chronic renal failure, occuring months or years after renal renal irradiation. It occurs due to affection of all renal components including the glomeruli, blood vessels, tubular epithelium and interstitium causing mesangiolysis, sclerosis, tubular atrophy and tubulointerstitial fibrosis.
The clinical presentation is azotemia, hypertension and disproportionately severe anemia.
Prevention would refer to therapies that must begin before the time of irradiation as the use of free radical scavengers such as amifostine & pentoxifylline (PTX). Prevention might also refer to therapies that could begin after irradiation but before there was overt evidence of clinical disease as angiotensin – converting enzyme inhibitors (ACE) and angiotensin type 1 receptor antagonist (AT1) to prevent the develop¬ment of radiation-induced renal injuries.
Radical scavengers are also used to decrease and prevent poduction of free radicals.
3D & 4D Conformal Radiation Therapy and Intensity Modulated Radiation Therapy (IMRT) play a recent important role in prevention of radiation nephropathy, as conformal radiotherapy aims to minimize the volume of normal tissue irradiated by shaping the dose distribution to conform tightly to the shape of the tumor reducing the dose delivered to normal tissues enabling a higher degree of targeted localization rather than conventional radiotherpy.
In treatment of radiation nephropathy, control of hypertension takes a special concern. Antihypertensive agents are an important part of clinical management for radiation nephropathy. The goal of therapy is to control the blood pressure to remain less than 130/85 mm Hg or 125/75 mm Hg if the patient has proteinuria of greater than 1000 mg/d.
No proof suggests that one type of antihypertensives is superior to another in these specific conditions. Nonetheless, ACE inhibitors are favored because of their known benefit in other progressive kidney diseases. Diuretics such as Hydrochlorothiazide (HCTZ) & furosemide are also used to control hypertension.
Other medications are used to control the clinical state of the case, such as cation exchange resins and mineralocorticoids are used for treatment of hyperkalemia. Also, antianemic agents like Epoetin and Darbepoetin alfa are used for treatment of associated anemia.
Follow-up of patients with radiation nephropathy plays an important role in stability of the clinical state of the patient by inpatient and outpatient care and patient education about medications and its use, also about risks of any new therapies involving radiation and complications of his/her case to control and improve the general health of the patient.