Radiation nephritis and intravascular coagulation.

A 23 year old male with embryonal cell carcinoma of the testicle was treated with radiation, receiving 2250 Rads to his abdomen twice, only once with kidney shielding. He developed acute renal failure approximately eleven months later. Associated with the renal failure were hemolytic anemia, thrombocytopenia, hypofibrinogenemia, and other evidence for intravascular coagulation. The kidney biopsy showed fibrinoid necrosis of arteries and arterioles. By electron microscopy, there was extensive endothelial cell damage and subendothelial electron lucent material compatible with radiation nephritis. The renal pathologic abnormalities suggest that the local renal vascular injury induced by radiation could have been responsible for intravascular coagulation in the kidneys and the systemic hematologic abnormalities. Prednisone appeared to accelerate the renal and hematologic dysfunction and heparin is proposed as a more promising therapy.