Renal consequences of irradiation of the spleen in lymphoma patients

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The authors have studied the consequences of irradiation of the upper part of the left kidney during treatment of the spleen. Seventy-four patients with lymphoma were entered in the study. They have all been followed up for between three and five years. Renal function was assessed by physical examination, biological tests, intravenous pyelograms and nephrotomographies, isotope scans with 197Hg neohydrin, dynamic studies with 131I hippuran and 99Tcm DTPA. No significant changes have been noted for blood pressure, biological tests or IVP. Eighteen months after irradiation renal tomograms showed cortical atrophy of the superior pole of the left kidney. 197Hg neohydrin started to show reduced uptake of the isotope in the irradiated region of the left kidney by the eighth month. 131I hippuran and 99Tcm DTPA detected abnormalities respectively five and three months after irradiation. No compensatory hypertrophy nor change in the overall kidney function have been noted. In Hodgkin's disease, radiotherapy has proved its efficiency in splenic involvement and the lack of secondary renal side effects. On the other hand, morbidity was shown to occur in 5% of cases after splenectomy. From these data, it is proposed to prefer radiotherapy rather than surgery for splenic treatment.