Radiation nephropathy is associated with a glomerular thrombotic microangiopathy and progression to end-stage kidney disease.

Radiation nephropathy is a rare complication following total body irradiation (TBI) and peptide receptor radionuclide therapy (PRRT). Yttrium 90-DOTATOC (Y90) is a somatostatin analogue labelled with Y90 used for somatostatin-positive neuroendocrine tumours. Y90 is renally excreted and has a cumulative effect in the renal parenchyma Despite fractionation and co-administration of renoprotective intravenous amino acids, targeted radionuclide therapy can still be nephrotoxic. Rising adoption of PRRT has led to the re-emergence of radiation nephropathy. We report on three recent cases of insidious onset of progressive kidney dysfunction and biopsy-proven thrombotic microangiopathy following PRRT and TBI.