Abstract: TH-PO0207
Radiation Nephritis Associated with Lutetium-177 Prostate-Specific Membrane Antigen
Session Information
- Onconephrology: Anticancer Therapies, PTLD, Paraneoplastic Diseases, and More
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Abid, Fareeha, Weill Cornell Medicine, New York, New York, United States
- Salvatore, Steven, Weill Cornell Medicine, New York, New York, United States
- Glezerman, Ilya, Memorial Sloan Kettering Cancer Center, New York, New York, United States
Introduction
Lutetium-177 prostate-specific membrane antigen (Lu-PSMA) is a peptide receptor radionuclide therapy approved for metastatic prostate cancer. We present a case of radiation nephropathy secondary to thrombotic microangiopathy (TMA) induced by Lu-PSMA
Case Description
A 76-year-old former smoker male with history of diabetes, and metastatic castration prostate cancer treated with multiple lines of therapy. Last therapy with 2 cycles of Lu-PSMA ten months prior to renal consultation. Presenting to clinic for acute kidney injury and hypertension. Patient complained of weight gain, and pedal edema. Around the same time, he was started on amlodipine 5 mg for new onset hypertension. His outpatient medications include tadalafil 5 mg, vibegron 75 mg, testosterone cypionate 0.3 ml every 7 days, ezetimibe 10 mg, rosuvastatin 5 mg and insulin. Vital signs significant for blood pressure 158/ 81 mmHg. Physical exam with bilateral lower extremity edema. Hemoglobin, platelets, LDH, haptogloblin, PSA and C3/C4 were within normal limits. Creatinine baseline 1.1 (0.6-1.3) mg/dl until four months prior to presentation and gradually increasing to 1.4 mg/dl at time of consultation. Testosterone at 803 ng/dl (221-716 ng/dl). No hematuria or pyuria with urinary protein to creatinine ration of 0.65 gm/d. Creatinine peaked at 1.8 mg/dl three months after presentation. Kidney biopsy was performed and showed chronic glomerular endothelial injury with global capillary wall double contour formation without active thrombi (Fig 1). Patient was diagnosed with radiation induced renal TMA and advised to avoid further exposure to Lu-PSMA.
Discussion
PSMA targeted radiotherapy (Lu-PSMA) causes dose dependent endothelial injury with histological features typical of TMA. Nephropathy attributed to binding of the drug to PSMA-like proteins expressed in the tubules leading to retention of beta emitter in the kidneys. Radiation renal injury is typically evident several months after irradiation.