A new cause of renal thrombotic microangiopathy: Yttrium 90-DOTATOC internal radiotherapy
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| Title: | A new cause of renal thrombotic microangiopathy: Yttrium 90-DOTATOC internal radiotherapy |
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| Authors: | Moll, Solange, Nickeleit, Volker, Müller-Brand, Jan, Brunner, Felix P., Mäcke, Helmut R., Mihatsch, Michael J. |
| Source: | American Journal of Kidney Diseases, Vol. 37, No 4 (2001) pp. 847-51 |
| Publisher Information: | Elsevier BV, 2001. |
| Publication Year: | 2001 |
| Subject Terms: | Male, Radiation Injuries/etiology/pathology, Kidney Failure, Chronic/etiology/pathology, Biopsy, Thrombosis, Middle Aged, Kidney/blood supply/pathology, Kidney, Octreotide, Kidney Diseases/etiology, Octreotide/adverse effects/analogs & derivatives/therapeutic use, Carcinoma, Neuroendocrine, 3. Good health, Carcinoma, Neuroendocrine/radiotherapy, 03 medical and health sciences, Yttrium Radioisotopes/adverse effects/therapeutic use, 0302 clinical medicine, Thrombosis/etiology/pathology, Humans, Kidney Failure, Chronic, Female, Kidney Diseases, Yttrium Radioisotopes, Radiation Injuries |
| Description: | The chelator somatostatin analogue dota-D-phe(1)-tyr(3)-octreotide (DOTATOC), which is stably labeled with the beta-emitting radioisotope yttrium 90 ((90)Y), is used as internal radiotherapy for the treatment of patients with advanced neuroendocrine tumors. We report 5 patients who developed chronic renal failure, caused in 3 patients by biopsy-proven thrombotic microangiopathy (TMA). Twenty-nine patients (14 men, 15 women) with normal renal function before therapy were treated with divided intravenous doses of (90)Y-DOTATOC approximately 6 weeks apart (mean normalized cumulative dose, 165.4 +/- 36.4 mCi/m(2)). Twenty-two of 29 patients were administered a normalized cumulative dose of 200 mCi/m(2) without side effects. Among the 7 patients (6 women, 1 man) administered a normalized cumulative dose greater than 200 mCi/m(2), 5 patients (4 women, 1 man) developed renal failure. Increasing serum creatinine levels were observed within 3 months after the last (90)Y-DOTATOC injection. The evolution was rapidly progressive in 3 patients, resulting in end-stage renal failure within 6 months. The remaining 2 patients developed chronic renal insufficiency (mean serum creatinine level, 300 micromol/L an average 16 months after the end of treatment). Renal biopsies performed in 3 patients showed typical signs of TMA involving glomeruli, arterioles, and small arteries. Patients treated with high-dose (90)Y-DOTATOC internal radiotherapy (cumulative dose > 200 mCi/m(2)) are at high risk to develop severe renal failure caused by TMA lesions. The histopathologic lesions are identical to those found after external radiotherapy, which suggests a causal relationship between (90)Y-DOTATOC and renal TMA. |
| Document Type: | Article |
| Language: | English |
| ISSN: | 0272-6386 |
| DOI: | 10.1016/s0272-6386(01)80135-9 |
| Access URL: | https://pubmed.ncbi.nlm.nih.gov/11273886 https://archive-ouverte.unige.ch/unige:40844 https://europepmc.org/article/MED/11273886 https://www.ajkd.org/article/S0272-6386(01)80135-9/fulltext https://www.sciencedirect.com/science/article/pii/S0272638601801359 https://www.ajkd.org/article/S0272638601801359/pdf https://www.ajkd.org/article/S0272-6386(01)80135-9/pdf https://archive-ouverte.unige.ch/unige:40844 |
| Rights: | Elsevier TDM |
| Accession Number: | edsair.doi.dedup.....2390e43d5a14cd50af5a0a3a411c0627 |
| Database: | OpenAIRE |
Nájsť tento článok vo Web of Science | Abstract: | The chelator somatostatin analogue dota-D-phe(1)-tyr(3)-octreotide (DOTATOC), which is stably labeled with the beta-emitting radioisotope yttrium 90 ((90)Y), is used as internal radiotherapy for the treatment of patients with advanced neuroendocrine tumors. We report 5 patients who developed chronic renal failure, caused in 3 patients by biopsy-proven thrombotic microangiopathy (TMA). Twenty-nine patients (14 men, 15 women) with normal renal function before therapy were treated with divided intravenous doses of (90)Y-DOTATOC approximately 6 weeks apart (mean normalized cumulative dose, 165.4 +/- 36.4 mCi/m(2)). Twenty-two of 29 patients were administered a normalized cumulative dose of 200 mCi/m(2) without side effects. Among the 7 patients (6 women, 1 man) administered a normalized cumulative dose greater than 200 mCi/m(2), 5 patients (4 women, 1 man) developed renal failure. Increasing serum creatinine levels were observed within 3 months after the last (90)Y-DOTATOC injection. The evolution was rapidly progressive in 3 patients, resulting in end-stage renal failure within 6 months. The remaining 2 patients developed chronic renal insufficiency (mean serum creatinine level, 300 micromol/L an average 16 months after the end of treatment). Renal biopsies performed in 3 patients showed typical signs of TMA involving glomeruli, arterioles, and small arteries. Patients treated with high-dose (90)Y-DOTATOC internal radiotherapy (cumulative dose > 200 mCi/m(2)) are at high risk to develop severe renal failure caused by TMA lesions. The histopathologic lesions are identical to those found after external radiotherapy, which suggests a causal relationship between (90)Y-DOTATOC and renal TMA. |
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| ISSN: | 02726386 |
| DOI: | 10.1016/s0272-6386(01)80135-9 |