Kidney Week

Abstract: FR-PO1248

The Long Tail of Peptide Receptor Radionuclide Therapy (PRRT): Uncommon Delayed Renal Dysfunction

Session Information

• Onconephrology: Diagnostic Dilemmas, Therapy-Related Toxicities, and Clinical Cases
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Onconephrology

• 1600 Onconephrology

Authors

• Khan, Asmad, TidalHealth Peninsula Regional, Salisbury, Maryland, United States

Asmad Khan, MD

• Ullah, Izhar, TidalHealth Peninsula Regional, Salisbury, Maryland, United States

Izhar Ullah, MD

• Salih, Noman, TidalHealth Peninsula Regional, Salisbury, Maryland, United States

Noman Salih, MD

• Hanif, Muhammad Owais, TidalHealth Peninsula Regional, Salisbury, Maryland, United States

Muhammad Owais Hanif, MD

• Arif, Ali, TidalHealth Peninsula Regional, Salisbury, Maryland, United States

Ali Arif, MD, MBBS, FASN

• Khan, Kazi S., TidalHealth Peninsula Regional, Salisbury, Maryland, United States

Kazi S. Khan, MD

Introduction

[177Lu]Lu-DOTATATE (Lutathera) is a PRRT approved for metastatic pancreatic neuroendocrine tumors (PNET). While effective, it carries nephrotoxic potential from cumulative renal radiation exposure. Mild renal impairment is relatively common; however, progression to severe renal dysfunction occurs in 1% of patients, typically as a delayed complication.

Case Description

A 76Y/M with hypertension, HFrEF 35%, and CKD 3b was diagnosed with metastatic PNET in 2004. Over the course of his disease, he was treated with temozolomide, sunitinib malate, and surgical resection of the gallbladder, spleen, and pancreatic tail, and was maintained on long-term octreotide; however, significant metastatic tumor burden persisted.
In 2021, he received 4 cycles of [177Lu]Lu-DOTATATE at 8-week intervals with concurrent amino acid infusion for renal protection. Renal function initially remained stable but progressively declined over the ensuing 36 months, with eGFR falling to 10, ultimately necessitating dialysis initiation. Kidney biopsy demonstrated 55–60% tubulointerstitial fibrosis and scarring, consistent with chronic progressive renal injury likely secondary to an allergic reaction to medication.

Discussion

This case illustrates the rare but clinically significant risk of renal dysfunction following PRRT. Radiation nephropathy results from proximal tubular reabsorption of the radiopeptide via the megalin/cubilin receptor complex, causing prolonged renal retention of beta-emitting radioactivity and cumulative parenchymal injury. In the ERASMUS registry, 1% of approximately 800 patients developed renal failure 3–36 months post-PRRT, with 2 requiring dialysis.
[177Lu]Lu-DOTATATE PRRT is an effective emerging therapy for metastatic PNET, but may rarely cause delayed renal dyfunction, especially in patients with underlying CKD. Long-term renal surveillance and early nephrology involvement are essential. Further studies are needed to better define this rare complication and guide monitoring strategies.