Chronic Renal Disorder after a Nuclear Crisis: A Brief Review

Abstract

A present global public health concern is the adverse effect from nuclear leakage crisis in Japan. Based on the previous data on a previous famous nuclear crisis, Chernobyl crisis, the chronic renal disorder in affected population is an interesting topic in nephrology. Here, the author briefly reviews and discusses on the chronic renal disorder and nuclear denotation. Disturbance to the renal cell, alteration of renal function, and disorder of nephrological system in offsprings of exposed subjects are the three main focused topics.

Keywords:

• Chronic
• renal
• disorder
• nuclear
• crisis

INTRODUCTION

A present global public health concern is the adverse effect from nuclear leakage crisis in Japan. Due to the disruption of the nuclear power plants in Japan after a big tsunami, the present nuclear crisis started and is not yet successfully controlled. The contaminated radioactive substances in the environment are expected to be the radiological hazard to the human beings.

Several health problems due to the nuclear leakage crisis can be seen. This is the topic for this discussion. Based on the previous data on a previous famous nuclear crisis, Chernobyl crisis, the chronic renal disorder in affected population is an interesting topic in nephrology. Here, the author briefly reviews and discusses on the chronic renal disorder and nuclear denotation.

Disturbance to the Renal Cell

A widely focused effect of exposure to leaked radiation is the alteration of normal cell structure. There are many studies on cancer epidemiology after the nuclear crisis. Based on the evidences in Chernobyl crisis, there are some reports on renal cell carcinoma. In Ukraine, an area with high exposure, an increased incidence of renal carcinoma can be observed (from 4.7 to 7.5 per 100,000 of total population).^1–3 Cesium 137 (¹³⁷Cs) is the main problematic radioactive element that results in oxidative disturbance in renal cell and can induce chronic radiation nephropathy.^1–3 A study on chronic radiation nephropathy of peritumoral kidney tissue by Romanenko et al.¹ showed good correlation of carcinogenesis with the duration of radiation exposure and confirmed the influence of chronic regular sustained low dose of ionizing radiation on renal carcinogenesis. The strong proliferating cell nuclear antigen and K-ras expression in cancer cell can be seen.^1–3 Radiation sclerosing proliferative atypical nephropathy with inactivation of p16 gene is confirmed as a precancerous lesion in affected Ukranians.^3–5 Romanenko et al.⁶ concluded that “chronic long-term, low-dose ionizing radiation exposure might result in global remodeling of extracellular matrix components of the clear cell renal cell carcinomas with disruption in peri-epithelial stroma and epithelial basement membranes.”

ALTERATION OF RENAL FUNCTION

The alteration of normal renal function can be expected. There are some reports on the observation of immunological disturbance that results in renal hypertension among exposed subjects.⁷ After exposure, the problematic nuclear particle, especially for ¹³⁷Cs, can induce several organ disorders.⁸ This can be acute or chronic disorders. The hemodialysis is recommended as an effective method to reduce the problematic particles.⁹

Focusing on the pathogenesis of renal dysfunction, the radioactive elements are believed to be the direct insult to the kidney as well as other organs. In a recent study, high concentration of ¹³⁷Cs can be seen in several organs including the kidney of the deceased patients who died within a year following the Chernobyl crisis.¹⁰ A statistically significant correlation was reported between cesium concentration and serum creatinine value.¹⁰ In addition, the disturbance of normal antioxidative system can deteriorate the renal function in the cases with the underlying renal problems.¹¹

Disorder of Nephrological System in Offsprings of Exposed Subjects

The problem occurs on not only the exposed subjects but also their offsprings. In case that the exposed subjects are the pregnant women, the problem can be expected on their offsprings. Indeed, the pregnant women are the vulnerable group to develop renal deficiency in nuclear crisis.^12,13 Increased renal problem and deterioration of renal function in the pregnant exposed to nuclear crisis are reported.^12,13 However, the problem might extend to their offsprings.¹²

In an animal study, Tissandie et al.¹⁴ concluded that “early exposure to post-accidental doses of ¹³⁷Cs induces the alteration of vitamin D metabolism, associated with a dysregulation of mineral homeostasis.” The disturbance of vitamin D metabolism might be an important etiopathological factor leading to the renal problem in offsprings. However, there is still no present confirmed evidence that the exposure increases the incidence of the renal disorder in the offsprings of exposed pregnant women.

CONCLUSION

The renal disturbances in either anatomical or physiological facets following exposure to leaked radiation in nuclear crisis can be seen. Taking into account the present Japanese crisis, it is wise to plan for prevention and set future follow-up studies on the chronic renal disturbance due to nuclear problems.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.