Decrease of Glomerular Filtration Rate may be Attributed to the Microcirculation Damage in Renal Artery Stenosis

Abstract

Background:The decrease of glomerular filtration rate has been theoretically supposed to be the result of low perfusion in renal artery stenosis (RAS). But the gap between artery stenosis and the glomerular filtration ability is still unclear.Methods:Patients with selective renal artery angiogram were divided by the degree of renal artery narrowing, level of estimated glomerular filtration rate (eGFR), respectively. The different levels of eGFR, renal microcirculation markers, and RAS severity were compared with each other, to determine the relationships among them.Results:A total of 215 consecutive patients were enrolled in the prospective cohort study. Concentrations of microcirculation markers had no significant difference between RAS group (RAS ≥ 50%) and no RAS group (RAS < 50%) or did not change correspondingly to RAS severity. The value of eGFR in RAS group was lower than that in the no RAS group, but it did not decline parallel to the progressive severity of RAS. The microcirculation markers presented integral difference if grouped by different eGFR level with negative tendency, especially that plasma cystatin C (cysC) and urinary microalbumin to creatinine ratio (mACR) increased with the deterioration of eGFR, with strong (r = −0.713, P < 0.001) and moderate (r = −0.580, P < 0.001) correlations. In the subgroup analysis of severe RAS (RAS ≥ 80%), the levels of plasma cysC and urinary mACR demonstrated stronger negative associations with eGFR, (r = −0.827, P < 0.001) and (r = −0.672, P < 0.001) correlations, respectively.Conclusions:Severity of RAS could not accurately predict the value of eGFR, whereas microcirculation impairment may substantially contribute to the glomerular filtration loss in patients with RAS.

Association of Chronic Kidney Disease with Coronary Heart Disease and Stroke Risks in Patients with Type 2 Diabetes Mellitus

“…Both these indexes have been used to evaluate the occurrence and development of renal dysfunction in patients with diabetes. [323435] However, a retrospective analysis of biopsy data has indicated that approximately 8% of Chinese T2DM patients may have co-existing diabetic nephropathy and nondiabetic renal disease. [36] Such comorbidities may affect prognosis and treatment, and the evaluation of CHD and stroke risks.…”

Contrast-Enhanced Ultrasound Assessment of Renal Parenchymal Perfusion in Patients with Atherosclerotic Renal Artery Stenosis to Predict Renal Function Improvement After Revascularization

“… 23 In our study, the baseline rGFR of the affected kidney was weakly correlated with the stenosis. Dong et al 24 also found that there was no significant correlation between the changes in GFR and the degree of renal artery stenosis. Moreover, many factors affect the changes in GFR (such as hypertension, nephritis or nephropathy, etc.…”