Low-energy shockwave therapy improves ischemic kidney microcirculation

Xin Zhang, James D. Krier, Carolina Amador Carrascal, James F Greenleaf, Behzad Ebrahimi, Ahmad F. Hedayat, Stephen C Textor, Amir Lerman, Lilach O Lerman

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Microvascular rarefaction distal to renal artery stenosis is linked to renal dysfunction and poor outcomes. Low-energy shockwave therapy stimulates angiogenesis, but the effect on the kidney microvasculature is unknown. We hypothesized that low-energy shockwave therapy would restore the microcirculation and alleviate renal dysfunction in renovascular disease. Normal pigs and pigs subjected to 3 weeks of renal artery stenosiswere treatedwith six sessions of low-energy shockwave (biweekly for 3 consecutiveweeks) or left untreated.We assessed BP, urinary protein, stenotic renal blood flow,GFR,microvascular structure, and oxygenation in vivo 4 weeks after completion of treatment, and then, we assessed expression of angiogenic factors and mechanotransducers (focal adhesion kinase and b1-integrin) ex vivo. A 3-week low-energy shockwave regimen attenuated renovascular hypertension, normalized stenotic kidney microvascular density and oxygenation, stabilized function, and alleviated fibrosis in pigs subjected to renal artery stenosis. These effects associated with elevated renal expression of angiogenic factors and mechanotransducers, particularly in proximal tubular cells. In additional pigs with prolonged (6 weeks) renal artery stenosis, shockwave therapy also decreased BP and improved GFR, microvascular density, and oxygenation in the stenotic kidney. This shockwave regimen did not cause detectable kidney injury in normal pigs. In conclusion, low-energy shockwave therapy improves stenotic kidney function, likely in part by mechanotransduction-mediated expression of angiogenic factors in proximal tubular cells, and it may ameliorate renovascular hypertension. Low-energy shockwave therapy may serve as a novel noninvasive intervention in the management of renovascular disease.

Original languageEnglish (US)
Pages (from-to)3715-3724
Number of pages10
JournalJournal of the American Society of Nephrology
Volume27
Issue number12
DOIs
StatePublished - Dec 1 2016

Fingerprint

Microcirculation
Kidney
Angiogenesis Inducing Agents
Swine
Renal Artery Obstruction
Renovascular Hypertension
Therapeutics
Focal Adhesion Protein-Tyrosine Kinases
Renal Circulation
Renal Artery
Disease Management
Microvessels
Integrins
Fibrosis
Wounds and Injuries

ASJC Scopus subject areas

  • Nephrology

Cite this

Low-energy shockwave therapy improves ischemic kidney microcirculation. / Zhang, Xin; Krier, James D.; Carrascal, Carolina Amador; Greenleaf, James F; Ebrahimi, Behzad; Hedayat, Ahmad F.; Textor, Stephen C; Lerman, Amir; Lerman, Lilach O.

In: Journal of the American Society of Nephrology, Vol. 27, No. 12, 01.12.2016, p. 3715-3724.

Research output: Contribution to journalArticle

Zhang, Xin ; Krier, James D. ; Carrascal, Carolina Amador ; Greenleaf, James F ; Ebrahimi, Behzad ; Hedayat, Ahmad F. ; Textor, Stephen C ; Lerman, Amir ; Lerman, Lilach O. / Low-energy shockwave therapy improves ischemic kidney microcirculation. In: Journal of the American Society of Nephrology. 2016 ; Vol. 27, No. 12. pp. 3715-3724.
@article{3ea974c8c33e4ff59c17a349f0bc7f09,
title = "Low-energy shockwave therapy improves ischemic kidney microcirculation",
abstract = "Microvascular rarefaction distal to renal artery stenosis is linked to renal dysfunction and poor outcomes. Low-energy shockwave therapy stimulates angiogenesis, but the effect on the kidney microvasculature is unknown. We hypothesized that low-energy shockwave therapy would restore the microcirculation and alleviate renal dysfunction in renovascular disease. Normal pigs and pigs subjected to 3 weeks of renal artery stenosiswere treatedwith six sessions of low-energy shockwave (biweekly for 3 consecutiveweeks) or left untreated.We assessed BP, urinary protein, stenotic renal blood flow,GFR,microvascular structure, and oxygenation in vivo 4 weeks after completion of treatment, and then, we assessed expression of angiogenic factors and mechanotransducers (focal adhesion kinase and b1-integrin) ex vivo. A 3-week low-energy shockwave regimen attenuated renovascular hypertension, normalized stenotic kidney microvascular density and oxygenation, stabilized function, and alleviated fibrosis in pigs subjected to renal artery stenosis. These effects associated with elevated renal expression of angiogenic factors and mechanotransducers, particularly in proximal tubular cells. In additional pigs with prolonged (6 weeks) renal artery stenosis, shockwave therapy also decreased BP and improved GFR, microvascular density, and oxygenation in the stenotic kidney. This shockwave regimen did not cause detectable kidney injury in normal pigs. In conclusion, low-energy shockwave therapy improves stenotic kidney function, likely in part by mechanotransduction-mediated expression of angiogenic factors in proximal tubular cells, and it may ameliorate renovascular hypertension. Low-energy shockwave therapy may serve as a novel noninvasive intervention in the management of renovascular disease.",
author = "Xin Zhang and Krier, {James D.} and Carrascal, {Carolina Amador} and Greenleaf, {James F} and Behzad Ebrahimi and Hedayat, {Ahmad F.} and Textor, {Stephen C} and Amir Lerman and Lerman, {Lilach O}",
year = "2016",
month = "12",
day = "1",
doi = "10.1681/ASN.2015060704",
language = "English (US)",
volume = "27",
pages = "3715--3724",
journal = "Journal of the American Society of Nephrology : JASN",
issn = "1046-6673",
publisher = "American Society of Nephrology",
number = "12",

}

TY - JOUR

T1 - Low-energy shockwave therapy improves ischemic kidney microcirculation

AU - Zhang, Xin

AU - Krier, James D.

AU - Carrascal, Carolina Amador

AU - Greenleaf, James F

AU - Ebrahimi, Behzad

AU - Hedayat, Ahmad F.

AU - Textor, Stephen C

AU - Lerman, Amir

AU - Lerman, Lilach O

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Microvascular rarefaction distal to renal artery stenosis is linked to renal dysfunction and poor outcomes. Low-energy shockwave therapy stimulates angiogenesis, but the effect on the kidney microvasculature is unknown. We hypothesized that low-energy shockwave therapy would restore the microcirculation and alleviate renal dysfunction in renovascular disease. Normal pigs and pigs subjected to 3 weeks of renal artery stenosiswere treatedwith six sessions of low-energy shockwave (biweekly for 3 consecutiveweeks) or left untreated.We assessed BP, urinary protein, stenotic renal blood flow,GFR,microvascular structure, and oxygenation in vivo 4 weeks after completion of treatment, and then, we assessed expression of angiogenic factors and mechanotransducers (focal adhesion kinase and b1-integrin) ex vivo. A 3-week low-energy shockwave regimen attenuated renovascular hypertension, normalized stenotic kidney microvascular density and oxygenation, stabilized function, and alleviated fibrosis in pigs subjected to renal artery stenosis. These effects associated with elevated renal expression of angiogenic factors and mechanotransducers, particularly in proximal tubular cells. In additional pigs with prolonged (6 weeks) renal artery stenosis, shockwave therapy also decreased BP and improved GFR, microvascular density, and oxygenation in the stenotic kidney. This shockwave regimen did not cause detectable kidney injury in normal pigs. In conclusion, low-energy shockwave therapy improves stenotic kidney function, likely in part by mechanotransduction-mediated expression of angiogenic factors in proximal tubular cells, and it may ameliorate renovascular hypertension. Low-energy shockwave therapy may serve as a novel noninvasive intervention in the management of renovascular disease.

AB - Microvascular rarefaction distal to renal artery stenosis is linked to renal dysfunction and poor outcomes. Low-energy shockwave therapy stimulates angiogenesis, but the effect on the kidney microvasculature is unknown. We hypothesized that low-energy shockwave therapy would restore the microcirculation and alleviate renal dysfunction in renovascular disease. Normal pigs and pigs subjected to 3 weeks of renal artery stenosiswere treatedwith six sessions of low-energy shockwave (biweekly for 3 consecutiveweeks) or left untreated.We assessed BP, urinary protein, stenotic renal blood flow,GFR,microvascular structure, and oxygenation in vivo 4 weeks after completion of treatment, and then, we assessed expression of angiogenic factors and mechanotransducers (focal adhesion kinase and b1-integrin) ex vivo. A 3-week low-energy shockwave regimen attenuated renovascular hypertension, normalized stenotic kidney microvascular density and oxygenation, stabilized function, and alleviated fibrosis in pigs subjected to renal artery stenosis. These effects associated with elevated renal expression of angiogenic factors and mechanotransducers, particularly in proximal tubular cells. In additional pigs with prolonged (6 weeks) renal artery stenosis, shockwave therapy also decreased BP and improved GFR, microvascular density, and oxygenation in the stenotic kidney. This shockwave regimen did not cause detectable kidney injury in normal pigs. In conclusion, low-energy shockwave therapy improves stenotic kidney function, likely in part by mechanotransduction-mediated expression of angiogenic factors in proximal tubular cells, and it may ameliorate renovascular hypertension. Low-energy shockwave therapy may serve as a novel noninvasive intervention in the management of renovascular disease.

UR - http://www.scopus.com/inward/record.url?scp=85019632358&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85019632358&partnerID=8YFLogxK

U2 - 10.1681/ASN.2015060704

DO - 10.1681/ASN.2015060704

M3 - Article

C2 - 27297945

AN - SCOPUS:85019632358

VL - 27

SP - 3715

EP - 3724

JO - Journal of the American Society of Nephrology : JASN

JF - Journal of the American Society of Nephrology : JASN

SN - 1046-6673

IS - 12

ER -