Radiation-associated kidney injury is a known complication of abdominal radiation in pediatric patients. Through systemic review of available literature, the PENTEC GU Task force aims to describe the relationships between RT dose, unilateral versus bilateral kidney irradiation, age at exposure, and chemotherapy administration; we then model risk of renal dysfunction. We conducted a comprehensive PubMed search of peer-reviewed manuscripts published from 1990-2017, among patients less than 18 years of age when irradiated. 2652 articles were retrieved. 98 met criteria for full review of which 19 contained usable radiation dose data for renal injury. Endpoints were heterogenous and included electrolyte abnormalities, estimated glomerular filtration (eGFR), imaging abnormalities, hypertension, and RTOG/ECOG or CTCAE grades. We grouped reported endpoints per National Kidney Foundation: mild (grade 1: normal eGFR > 90 with only elevated Cr), moderate (grade 2: eGFR 60-89) and severe (grades 3-5: eGFR <60, dialysis, or transplant). We modelled TBI separately from Wilms/Other. The 19 articles analyzed included long term follow up on patients with a history of Wilms (9), TBI (9), and “other” (1). A total of 1233 pediatrics patients were evaluated, 326 Wilms, 781 TBI with stem cell transplant and 126 with other diagnoses. The age range at the time of radiation was 1 month-18 years with medians of 2-14 years. Study time periods ranged from 1962-2014 with median follow-ups of 0.4-19 years with a weighted average of 10.1 years. Based on CKD groupings, dysfunction by grade were reported to be 2.8-32% (I), 0-8% (II), 0-16% (III-V). We modeled risk of dysfunction by dose and grade of toxicity. Given the heterogeneity of chemotherapy regimens and lack of reported chemotherapy-based toxicity, we were unable to include chemotherapy in our analysis. Age-specific data was lacking. NCTP of greater than 5% occurred in the setting of non-TBI unilateral kidney radiation at 17.8, 25.3 and 31.5 Gy, for grades I, II, and III-V, respectively. We are in the process of modeling the NCTP with Total Body Irradiation. We have estimated the risk of graded renal toxicity based on non-TBI unilateral whole kidney radiation exposure. Partial kidney radiation estimates could not be modeled due to limited reported dosimetric data. Chemotherapy likely plays a role in the risk of long-term renal dysfunction, but could not be modeled. Age at exposure could not be assessed. Based on current dose guidelines with Wilms tumor patients, the risk of moderate and severe kidney toxicity is low. Our efforts support the critical need for improved data gathering and reporting in future clinical trials.Abstract 1126; Table 1Dose for NCTP model with 5% risk of toxicityGrade I Abnormal BUN/Cr or elevated Cr. eGFR > 90Grade II Impaired function, eGFR 60-90Grade III/IV eGFR < 60 or renal failure17.8 Gy25.3 Gy31.5 GyPENTEC acknowledges logistical support from American Association of Physicists in Medicine. Open table in a new tab