Table 2.

Key teaching points

•Temporal relationship between the onset of worsening kidney function and administration of actinium-225 (225Ac)–prostate-specific membrane antigen (PSMA)617 in our patients is very suggestive of a drug association. Moreover, biopsy findings and their similarity to animal models of this type of injury is strongly suggestive of therapy-related toxicity.

•Our cases emphasize the need for careful assessment and long-term monitoring of kidney function in patients receiving targeted radionuclide therapy with 225Ac-PSMA617, especially if preexisting kidney impairment is present.

•As with many newer promising cancer therapies, unforeseen kidney risks may be present and practitioners in both nephrology and oncology must be aware of these potential adverse effects.