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Changes in glomerular filtration rate after renal revascularization correlate with microvascular hemodynamics and inflammation in Swine renal artery stenosis.
- Source :
-
Circulation. Cardiovascular interventions [Circ Cardiovasc Interv] 2012 Oct; Vol. 5 (5), pp. 720-8. Date of Electronic Publication: 2012 Oct 09. - Publication Year :
- 2012
-
Abstract
- Background: The selection of patients with renal artery stenosis (RAS) likely to improve glomerular filtration rate (GFR) after percutaneous transluminal renal angioplasty is difficult. We examined basal hemodynamic and inflammatory factors linked to improved stenotic kidney (STK) function after percutaneous transluminal renal angioplasty in swine RAS.<br />Methods and Results: Fifteen pigs after 6 weeks of hemodynamically significant RAS were studied before and 4 weeks after technically successful percutaneous transluminal renal angioplasty+stenting. STK and contralateral kidney hemodynamics and function were evaluated by multidetector computed-tomography before and after acetylcholine challenge. Single-kidney deoxyhemoglobin (R2*, reciprocal to blood relaxation) and energy-dependent tubular function were assessed using blood-oxygen-level-dependent magnetic resonance imaging before and after furosemide. Baseline renal vein and inferior vena cava levels of inflammatory markers were measured and their gradient and net release calculated. Baseline parameters were compared with normal (n=7) and sham-RAS (n=7) pigs and correlated with the change in STK-GFR after revascularization (ΔGFR). Four weeks after percutaneous transluminal, renal angioplasty blood pressure was normalized in all animals, but STK-GFR improved in 10 of 15 (ΔGFR =+22.0±8.5 mL/min). ΔGFR correlated inversely with basal STK-GFR, renal release of inflammatory markers, and medullary R2* response to furosemide, but directly with GFR response to acetylcholine. Basal contralateral kidney GFR correlated directly with ΔGFR.<br />Conclusions: Low basal STK-GFR with preserved response to acetylcholine may predict benefit from revascularization in RAS, whereas renal inflammation and robust STK-R2* responses to furosemide (possibly reflecting avid tubular oxygen consumption) are associated with less favorable outcomes. These tools may be useful for identification of patients likely to improve renal function after revascularization.
- Subjects :
- Acetylcholine pharmacology
Animals
Biomarkers blood
Disease Models, Animal
Female
Furosemide pharmacology
Inflammation Mediators blood
Kidney diagnostic imaging
Kidney drug effects
Magnetic Resonance Imaging
Nephritis blood
Nephritis diagnosis
Nephritis immunology
Nephritis physiopathology
Renal Artery physiopathology
Renal Artery Obstruction blood
Renal Artery Obstruction diagnosis
Renal Artery Obstruction immunology
Renal Artery Obstruction physiopathology
Renal Veins physiopathology
Stents
Sus scrofa
Time Factors
Tomography, X-Ray Computed
Angioplasty, Balloon adverse effects
Angioplasty, Balloon instrumentation
Glomerular Filtration Rate drug effects
Hemodynamics drug effects
Kidney blood supply
Kidney physiopathology
Microcirculation drug effects
Microvessels physiopathology
Nephritis prevention & control
Renal Artery Obstruction therapy
Renal Circulation drug effects
Subjects
Details
- Language :
- English
- ISSN :
- 1941-7632
- Volume :
- 5
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Circulation. Cardiovascular interventions
- Publication Type :
- Academic Journal
- Accession number :
- 23048054
- Full Text :
- https://doi.org/10.1161/CIRCINTERVENTIONS.112.972596