Noninvasive evaluation of a novel swine model of renal artery stenosis

Lilach O Lerman, Robert S. Schwartz, Joseph Peter Grande, Patrick F. Sheedy, J. Carlos Romero

Research output: Contribution to journalArticle

117 Citations (Scopus)

Abstract

Intrarenal hemodynamics and excretory function distal to renal artery stenosis are difficult to quantify noninvasively. In this study, a swine model of chronic unilateral renal artery stenosis, achieved by implantation of an intravascular device that leads to a gradual and progressive luminal area narrowing, was developed and evaluated. Bilateral cortical and medullary volumes, blood flows, and segmental tubular dynamics were assessed in the intact kidneys of seven pigs using electron-beam computerized tomography before and 1 mo after implantation of the device. Within 1 mo, a 66% angiographic stenosis was significantly correlated with a 25% increase in BP. The volume and blood flow were markedly lower in the stenotic compared with the contralateral kidney and cortex, while the medulla exhibited minimal changes. In the stenotic kidney, intratubular contrast content has decreased in all nephron segments, especially in the distal tubule, where it correlated with an increase in serum creatinine and stenosis severity. In the contralateral kidney, dilution of proximal tubular fluid correlated with the increase in BP, likely due to pressure-natriuresis. In conclusion, the swine model closely resembles human renovascular hypertension. In the stenotic kidney, the hemodynamic impairment of the cortex is dissociated from the relatively preserved renal medulla, and the earliest effect on excretory function is observed in the distal nephron, where the fall in the amount of fluid reaching that segment is directly proportional to the renal arterial compromise. Electron-beam computerized tomography shows promise to noninvasively quantify, follow-up, and study changes in concurrent, in vivo intrarenal hemodynamics and segmental tubular function in renovascular hypertension.

Original languageEnglish (US)
Pages (from-to)1455-1465
Number of pages11
JournalJournal of the American Society of Nephrology
Volume10
Issue number7
StatePublished - Jul 1999

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Renal Artery Obstruction
Swine
Kidney
Renovascular Hypertension
X Ray Computed Tomography
Hemodynamics
Nephrons
Blood Volume
Pathologic Constriction
Kidney Cortex
Equipment and Supplies
Natriuresis
Creatinine
Pressure
Serum

ASJC Scopus subject areas

  • Nephrology

Cite this

Noninvasive evaluation of a novel swine model of renal artery stenosis. / Lerman, Lilach O; Schwartz, Robert S.; Grande, Joseph Peter; Sheedy, Patrick F.; Romero, J. Carlos.

In: Journal of the American Society of Nephrology, Vol. 10, No. 7, 07.1999, p. 1455-1465.

Research output: Contribution to journalArticle

Lerman, Lilach O ; Schwartz, Robert S. ; Grande, Joseph Peter ; Sheedy, Patrick F. ; Romero, J. Carlos. / Noninvasive evaluation of a novel swine model of renal artery stenosis. In: Journal of the American Society of Nephrology. 1999 ; Vol. 10, No. 7. pp. 1455-1465.
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