Radiation Nephrotoxicity:
a) Immediate: decreased renal blood flow and glomerular filtration rate.
b) Early: acute nephritis
c) Late: chronic nephritis, obstructive uropathy, urinary fistula and fluid
and electrolyte depletion.
Infective (biological) environmental risk factors
a) Parasitic: for example malaria, schistosoma and hydatid disease.
b) Bacterial: for example tuberculosis.
c) Viral: for example viral hepatitis and HIV.
d) Fungal toxins: especially ochratoxin and aflatoxin.Ochratoxins arise from fungus Aspergillus ochraceus, discovered
in the mid 1960s during a search for new toxic substances from moulds. It
was discovered to be a natural contaminant of maize (Fig. 11.1), and to be
the cause of porcine nephropathy in Scandinavia by 1978. It is established
as grain contaminant and a cause of porcine nephropathy in Europe and
USA.
Ochratoxin nephrotoxicity
- Ochratoxins induce nephropathy and kidney tumours in rodents, dogs,
pigs and birds. - It induces endemic porcine nephropathy in central and northern
European countries. - It most probably has a major role in the aetiology of Balkan endemic
nephropathy which is characterised by chronic tubulo-interstitial
disease (Fig. 11.2) progressing to end stage renal failure and urethral
tumours, a picture similar to porcine nephropathy.