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Updated: Sep 16, 2025

A Whole Body Dosimetry Protocol for Peptide-Receptor Radionuclide Therapy PRRT: 2D Planar Image and Hybrid 2D+3D SPECT/CT Image Methods
Published on: April 24, 2020
Peptide receptor radionuclide therapy: a new era of radiation nephropathy
Abhirami Das1, Ayse Tuba Kendi2, Sandhya Manohar1
1Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL, USA.
Abstract:
Peptide receptor radionuclide therapy (PRRT) has transformed the management of neuroendocrine tumors and other malignancies by enabling targeted radiation delivery while minimizing systemic toxicity. However, incidental renal radiation exposure presents a significant risk of radiation nephropathy, and this risk varies based on the unique characteristics of the radionuclide and its decay phenomenon as well as the peptide being utilized. This review explores the historical development of PRRT, the physics of radionuclide therapy as necessary for a practicing nephrologist, and key mechanisms of radiation-related kidney injury. We detail renal handling of radionuclides, dose thresholds and pathological features of PRRT-induced nephropathy. Furthermore, we discuss both current and prospective strategies to reduce renal toxicity-such as amino acid infusions, receptor saturation, cleavable linkers and emerging protective agents. Special considerations for PRRT in patients with chronic kidney disease and those on dialysis are highlighted. As PRRT applications expand, multidisciplinary collaboration is essential to optimize renal safety.
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