Preserved oxygenation despite reduced blood flow in poststenotic kidneys in human atherosclerotic renal artery stenosis

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Abstract

Atherosclerotic renal artery stenosis reduces blood flow and perfusion pressures to the poststenotic kidney producing renovascular hypertension and threatening glomerular filtration rate. Little is known regarding regional tissue oxygenation in human renovascular disease that develops slowly. We compared stenotic and contralateral kidneys regarding volume, tissue perfusion, blood flow measured by multidetector computed tomography, and blood oxygen level-dependent magnetic resonance values in the cortex and medulla in 14 patients with unilateral stenosis (mean: 71% by quantitative computed tomography) and in 14 essential hypertensive patients during 150 mEq/d of sodium intake and renin-angiotensin blockade. Stenotic kidney volume was reduced compared with the contralateral kidney (118.6±9.9 versus 155.4±13.7 mL; P<0.01), as was total blood flow (269.7±42.2 versus 383.7±49; P=0.02), mainly beCause of reduced cortiCal volume. Tissue perfusion was similar but lower than essential hypertension (1.5 versus 1.2 mL/min per milliliter; P<0.05). Blood oxygen level-dependent MR at 3 T confirmed elevated R2* values (a measure of deoxyhemoglobin) in deep medullary regions in all 3 sets of kidneys (38.9±0.7 versus cortex 17.8±0.36 s; P<0.0001). Despite reduced blood flow, R2* values did not differ between atherosclerotic and essential hypertensive kidneys, although furosemide-suppressible fall in medullary R2* was reduced in stenotic kidneys (5.7±1.8 versus 9.4±1.9 s; P<0.05). Renal venous oxygen levels from the stenotic kidney were higher than those from essential hypertensives (65.1±2.2 versus 58.1±1.2; P=0.006). These data indiCate that, although stenosis reduced blood flow and volume, cortiCal and medullary oxygenation was preserved under these conditions.

Original languageEnglish (US)
Pages (from-to)961-966
Number of pages6
JournalHypertension
Volume55
Issue number4
DOIs
StatePublished - Apr 2010

Fingerprint

Renal Artery Obstruction
Kidney
Perfusion
Oxygen
Pathologic Constriction
Renovascular Hypertension
Multidetector Computed Tomography
Furosemide
Angiotensins
Blood Volume
Glomerular Filtration Rate
Renin
Magnetic Resonance Spectroscopy
Sodium
Tomography
Pressure

Keywords

  • BOLD MR
  • Hypertension
  • Ischemia
  • Oxygen
  • Renal artery stenosis
  • Renin
  • Renovascular hypertension

ASJC Scopus subject areas

  • Internal Medicine

Cite this

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title = "Preserved oxygenation despite reduced blood flow in poststenotic kidneys in human atherosclerotic renal artery stenosis",
abstract = "Atherosclerotic renal artery stenosis reduces blood flow and perfusion pressures to the poststenotic kidney producing renovascular hypertension and threatening glomerular filtration rate. Little is known regarding regional tissue oxygenation in human renovascular disease that develops slowly. We compared stenotic and contralateral kidneys regarding volume, tissue perfusion, blood flow measured by multidetector computed tomography, and blood oxygen level-dependent magnetic resonance values in the cortex and medulla in 14 patients with unilateral stenosis (mean: 71{\%} by quantitative computed tomography) and in 14 essential hypertensive patients during 150 mEq/d of sodium intake and renin-angiotensin blockade. Stenotic kidney volume was reduced compared with the contralateral kidney (118.6±9.9 versus 155.4±13.7 mL; P<0.01), as was total blood flow (269.7±42.2 versus 383.7±49; P=0.02), mainly beCause of reduced cortiCal volume. Tissue perfusion was similar but lower than essential hypertension (1.5 versus 1.2 mL/min per milliliter; P<0.05). Blood oxygen level-dependent MR at 3 T confirmed elevated R2* values (a measure of deoxyhemoglobin) in deep medullary regions in all 3 sets of kidneys (38.9±0.7 versus cortex 17.8±0.36 s; P<0.0001). Despite reduced blood flow, R2* values did not differ between atherosclerotic and essential hypertensive kidneys, although furosemide-suppressible fall in medullary R2* was reduced in stenotic kidneys (5.7±1.8 versus 9.4±1.9 s; P<0.05). Renal venous oxygen levels from the stenotic kidney were higher than those from essential hypertensives (65.1±2.2 versus 58.1±1.2; P=0.006). These data indiCate that, although stenosis reduced blood flow and volume, cortiCal and medullary oxygenation was preserved under these conditions.",
keywords = "BOLD MR, Hypertension, Ischemia, Oxygen, Renal artery stenosis, Renin, Renovascular hypertension",
author = "Gloviczki, {Monika L.} and James Glockner and Lerman, {Lilach O} and McKusick, {Michael A.} and Sanjay Misra and Grande, {Joseph Peter} and Textor, {Stephen C}",
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T1 - Preserved oxygenation despite reduced blood flow in poststenotic kidneys in human atherosclerotic renal artery stenosis

AU - Gloviczki, Monika L.

AU - Glockner, James

AU - Lerman, Lilach O

AU - McKusick, Michael A.

AU - Misra, Sanjay

AU - Grande, Joseph Peter

AU - Textor, Stephen C

PY - 2010/4

Y1 - 2010/4

N2 - Atherosclerotic renal artery stenosis reduces blood flow and perfusion pressures to the poststenotic kidney producing renovascular hypertension and threatening glomerular filtration rate. Little is known regarding regional tissue oxygenation in human renovascular disease that develops slowly. We compared stenotic and contralateral kidneys regarding volume, tissue perfusion, blood flow measured by multidetector computed tomography, and blood oxygen level-dependent magnetic resonance values in the cortex and medulla in 14 patients with unilateral stenosis (mean: 71% by quantitative computed tomography) and in 14 essential hypertensive patients during 150 mEq/d of sodium intake and renin-angiotensin blockade. Stenotic kidney volume was reduced compared with the contralateral kidney (118.6±9.9 versus 155.4±13.7 mL; P<0.01), as was total blood flow (269.7±42.2 versus 383.7±49; P=0.02), mainly beCause of reduced cortiCal volume. Tissue perfusion was similar but lower than essential hypertension (1.5 versus 1.2 mL/min per milliliter; P<0.05). Blood oxygen level-dependent MR at 3 T confirmed elevated R2* values (a measure of deoxyhemoglobin) in deep medullary regions in all 3 sets of kidneys (38.9±0.7 versus cortex 17.8±0.36 s; P<0.0001). Despite reduced blood flow, R2* values did not differ between atherosclerotic and essential hypertensive kidneys, although furosemide-suppressible fall in medullary R2* was reduced in stenotic kidneys (5.7±1.8 versus 9.4±1.9 s; P<0.05). Renal venous oxygen levels from the stenotic kidney were higher than those from essential hypertensives (65.1±2.2 versus 58.1±1.2; P=0.006). These data indiCate that, although stenosis reduced blood flow and volume, cortiCal and medullary oxygenation was preserved under these conditions.

AB - Atherosclerotic renal artery stenosis reduces blood flow and perfusion pressures to the poststenotic kidney producing renovascular hypertension and threatening glomerular filtration rate. Little is known regarding regional tissue oxygenation in human renovascular disease that develops slowly. We compared stenotic and contralateral kidneys regarding volume, tissue perfusion, blood flow measured by multidetector computed tomography, and blood oxygen level-dependent magnetic resonance values in the cortex and medulla in 14 patients with unilateral stenosis (mean: 71% by quantitative computed tomography) and in 14 essential hypertensive patients during 150 mEq/d of sodium intake and renin-angiotensin blockade. Stenotic kidney volume was reduced compared with the contralateral kidney (118.6±9.9 versus 155.4±13.7 mL; P<0.01), as was total blood flow (269.7±42.2 versus 383.7±49; P=0.02), mainly beCause of reduced cortiCal volume. Tissue perfusion was similar but lower than essential hypertension (1.5 versus 1.2 mL/min per milliliter; P<0.05). Blood oxygen level-dependent MR at 3 T confirmed elevated R2* values (a measure of deoxyhemoglobin) in deep medullary regions in all 3 sets of kidneys (38.9±0.7 versus cortex 17.8±0.36 s; P<0.0001). Despite reduced blood flow, R2* values did not differ between atherosclerotic and essential hypertensive kidneys, although furosemide-suppressible fall in medullary R2* was reduced in stenotic kidneys (5.7±1.8 versus 9.4±1.9 s; P<0.05). Renal venous oxygen levels from the stenotic kidney were higher than those from essential hypertensives (65.1±2.2 versus 58.1±1.2; P=0.006). These data indiCate that, although stenosis reduced blood flow and volume, cortiCal and medullary oxygenation was preserved under these conditions.

KW - BOLD MR

KW - Hypertension

KW - Ischemia

KW - Oxygen

KW - Renal artery stenosis

KW - Renin

KW - Renovascular hypertension

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