Changes in glomerular filtration rate after renal revascularization correlate with microvascular hemodynamics and infilammation in swine renal artery stenosis

Alfonso Eirin, Behzad Ebrahimi, Xin Zhang, Xiang Yang Zhu, Hui Tang, John A. Crane, Amir Lerman, Stephen C Textor, Lilach O Lerman

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background: The selection of patients with renal artery stenosis (RAS) likely to improve glomerular fltration rate (GFR) after percutaneous transluminal renal angioplasty is difficult. We examined basal hemodynamic and infilammatory factors linked to improved stenotic kidney (STK) function after percutaneous transluminal renal angioplasty in swine RAS. 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 infilammatory 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 infilammatory markers, and medullary R2 * response to furosemide, but directly with GFR response to acetylcholine. Basal contralateral kidney GFR correlated directly with ΔGFR. Conclusions: Low basal STK-GFR with preserved response to acetylcholine may predict benefit from revascularization in RAS, whereas renal infilammation 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.

Original languageEnglish (US)
Pages (from-to)720-728
Number of pages9
JournalCirculation: Cardiovascular Interventions
Volume5
Issue number5
DOIs
StatePublished - Oct 2012

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Renal Artery Obstruction
Glomerular Filtration Rate
Swine
Hemodynamics
Kidney
Angioplasty
Furosemide
Acetylcholine
Renal Veins
Multidetector Computed Tomography
Inferior Vena Cava

Keywords

  • Cytokines
  • Hemodynamics
  • Hypertension
  • Infilammation
  • Renal

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{a7d8f234447e4daab1a4513b128711e3,
title = "Changes in glomerular filtration rate after renal revascularization correlate with microvascular hemodynamics and infilammation in swine renal artery stenosis",
abstract = "Background: The selection of patients with renal artery stenosis (RAS) likely to improve glomerular fltration rate (GFR) after percutaneous transluminal renal angioplasty is difficult. We examined basal hemodynamic and infilammatory factors linked to improved stenotic kidney (STK) function after percutaneous transluminal renal angioplasty in swine RAS. 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 infilammatory 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 infilammatory markers, and medullary R2 * response to furosemide, but directly with GFR response to acetylcholine. Basal contralateral kidney GFR correlated directly with ΔGFR. Conclusions: Low basal STK-GFR with preserved response to acetylcholine may predict benefit from revascularization in RAS, whereas renal infilammation 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.",
keywords = "Cytokines, Hemodynamics, Hypertension, Infilammation, Renal",
author = "Alfonso Eirin and Behzad Ebrahimi and Xin Zhang and Zhu, {Xiang Yang} and Hui Tang and Crane, {John A.} and Amir Lerman and Textor, {Stephen C} and Lerman, {Lilach O}",
year = "2012",
month = "10",
doi = "10.1161/CIRCINTERVENTIONS.112.972596",
language = "English (US)",
volume = "5",
pages = "720--728",
journal = "Circulation: Cardiovascular Interventions",
issn = "1941-7640",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Changes in glomerular filtration rate after renal revascularization correlate with microvascular hemodynamics and infilammation in swine renal artery stenosis

AU - Eirin, Alfonso

AU - Ebrahimi, Behzad

AU - Zhang, Xin

AU - Zhu, Xiang Yang

AU - Tang, Hui

AU - Crane, John A.

AU - Lerman, Amir

AU - Textor, Stephen C

AU - Lerman, Lilach O

PY - 2012/10

Y1 - 2012/10

N2 - Background: The selection of patients with renal artery stenosis (RAS) likely to improve glomerular fltration rate (GFR) after percutaneous transluminal renal angioplasty is difficult. We examined basal hemodynamic and infilammatory factors linked to improved stenotic kidney (STK) function after percutaneous transluminal renal angioplasty in swine RAS. 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 infilammatory 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 infilammatory markers, and medullary R2 * response to furosemide, but directly with GFR response to acetylcholine. Basal contralateral kidney GFR correlated directly with ΔGFR. Conclusions: Low basal STK-GFR with preserved response to acetylcholine may predict benefit from revascularization in RAS, whereas renal infilammation 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.

AB - Background: The selection of patients with renal artery stenosis (RAS) likely to improve glomerular fltration rate (GFR) after percutaneous transluminal renal angioplasty is difficult. We examined basal hemodynamic and infilammatory factors linked to improved stenotic kidney (STK) function after percutaneous transluminal renal angioplasty in swine RAS. 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 infilammatory 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 infilammatory markers, and medullary R2 * response to furosemide, but directly with GFR response to acetylcholine. Basal contralateral kidney GFR correlated directly with ΔGFR. Conclusions: Low basal STK-GFR with preserved response to acetylcholine may predict benefit from revascularization in RAS, whereas renal infilammation 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.

KW - Cytokines

KW - Hemodynamics

KW - Hypertension

KW - Infilammation

KW - Renal

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DO - 10.1161/CIRCINTERVENTIONS.112.972596

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