
Radiation nephropathy is renal injury and loss of function affected by ionizing radiation. The major risk with radiation nephropathy and bone marrow transplant (BMT) nephropathy is progressive loss of renal function with evolution to end-stage renal failure. The radiation nephropathy usually occurs after sufficient irradiation of both kidneys. The renal failure may be accelerated due to uncontrolled hypertension, hence to control the loss of renal function, blood pressure must be maintained. Thus, antihypertensive agents are an important part of clinical management of radiation nephropathy or BMT nephropathy. The goal of therapy is to keep blood pressure at less than 130/85 mm Hg or 125/75 mm Hg if the patient has proteinuria of greater than 1000 mg/d. Moreover, due to its uncommon characteristics, there are no controlled trials to guide the management of radiation nephropathy. Hence, radiation nephropathy treatment and management is guided by the same principles of treatment of any hypertensive kidney disease, including renovascular hypertension, blood pressure control and correction of metabolic acidosis. The most important blood pressure medications to treat renal hypertension include: ACE inhibitors (angiotensin converting enzyme inhibitors). These include ramipril, benazepril, captopril, lisinopril, and others; and ARBs (angiotensin II receptor blockers). Examples include candesartan, losartan, olmesartan and valsartan. However, some people with renal hypertension can be helped by angioplasty, stenting, or surgery on the blood vessels of the kidney.