Extensive 177Lu-PSMA Radioligand Therapy Can Lead to Radiation Nephropathy with a Renal Thrombotic Microangiopathy-like Picture

Hannah Schäfer; Sarah Mayr; Maike Büttner-Herold; Karina Knorr; Lisa Steinhelfer; Carsten A Böger; Jürgen E Gschwend; Uwe Heemann; Matthias Eiber; Christoph Schmaderer; Robert Tauber

doi:10.1016/j.eururo.2022.05.025

Extensive ¹⁷⁷Lu-PSMA Radioligand Therapy Can Lead to Radiation Nephropathy with a Renal Thrombotic Microangiopathy-like Picture

Eur Urol. 2023 May;83(5):385-390. doi: 10.1016/j.eururo.2022.05.025. Epub 2022 Jun 7.

Authors

Affiliations

¹ Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany. Electronic address: [email protected].
² Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
³ Department of Nephropathology, Institute of Pathology, Friedrich-Alexander University Erlangen-Nürnberg and University Hospital Erlangen, Erlangen, Germany.
⁴ Department of Nuclear Medicine, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
⁵ Department of Nephrology, Diabetology and Rheumatology, Hospital Traunstein, Traunstein, Germany; KfH Kidney Center Traunstein, Traunstein, Germany; Department of Nephrology, University Hospital Regensburg, Regensburg, Germany.
⁶ Department of Urology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
⁷ Department of Urology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany. Electronic address: [email protected].

PMID: 35688660
DOI: 10.1016/j.eururo.2022.05.025

Abstract

Lutetium-177 prostate-specific membrane antigen (¹⁷⁷Lu-PSMA) radioligand therapy is an option that is increasingly being used for treatment of metastatic castration-resistant prostate cancer. This delivers β-radiation to cells expressing PSMA and high accumulation of the radiopharmaceutical occurs in the kidneys. Here we report three cases of radiation nephropathy with severe chronic kidney disease induced by renal thrombotic microangiopathy following extensive treatment with ¹⁷⁷Lu-PSMA radioligand therapy.

Keywords: (177)Lu-PSMA; Chronic kidney disease; Metastatic castration-resistant prostate cancer; Prostate cancer; Radiation nephropathy; Radioligand therapy; Renal toxicity; Theranostics; Thrombotic microangiopathy; Tubulotoxicity.

Publication types

Case Reports

MeSH terms

Dipeptides
Humans
Kidney / pathology
Lutetium / therapeutic use
Male
Prostate-Specific Antigen
Prostatic Neoplasms, Castration-Resistant* / pathology
Prostatic Neoplasms, Castration-Resistant* / radiotherapy
Thrombotic Microangiopathies*
Treatment Outcome

Substances

Prostate-Specific Antigen
Dipeptides
Lutetium