Estimation of Intraglomerular Pressure Using Invasive Renal Arterial Pressure and Flow Velocity Measurements in Humans

Collard, Didier; Brussel, Peter M. van; Velde, Lennart van de; Wijntjens, Gilbert; Westerhof, Berend E.; Karemaker, John M.; Piek, Jan J.; Reekers, Jim A.; Vogt, Liffert; Winter, Robbert J. de; Born, Bert‐Jan H. van den

doi:10.1681/asn.2019121272

Cited by 7 publications

(4 citation statements)

References 48 publications

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“…Additionally, average estimates of the ultrafiltration coefficient derived from micropuncture studies were used in the analysis. However, our P GLO values are consistent with those obtained using invasive renal arterial pressure and flow velocity measurements in participants with T2D (23). Furthermore, Gomez equation parameters do not reflect single-nephron function.…”

Section: Discussionsupporting

confidence: 82%

“…For example, participants from the high-risk unstable trajectory of P GLO had significantly higher baseline P GLO than their peers from the low-risk stable trajectory, followed by a more rapid decline of P GLO . Other studies using Gomez equations or invasive measures of renal arterial pressure and flow velocity established that P GLO is 45-55 mmHg in healthy control subjects and is, on average, 10 mmHg higher in individuals with T2D (12,23). By these criteria, participants in the high-risk trajectory of P GLO exhibited early intraglomerular hypertension.…”

Section: Discussionmentioning

confidence: 98%

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Intraglomerular Dysfunction Predicts Kidney Failure in Type 2 Diabetes

Saulnier

Looker²,

Mauer

et al. 2021

Diabetes

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No longitudinal data link intraglomerular hemodynamic dysfunction with end-stage kidney disease (ESKD) in people with type 2 diabetes (T2D). Afferent (R A ) and efferent (R E ) arteriolar resistance and intraglomerular pressure (P GLO ) are not directly measurable in humans but are estimable from glomerular filtration rate (GFR), renal plasma flow (RPF), blood pressure, hematocrit, and plasma oncotic pressure. We examined the association of the R A -to-R E ratio and P GLO with ESKD incidence in 237 Pima Indian individuals with T2D who underwent serial measures of GFR (iothalamate) and RPF (p-aminohippurate). Their association with kidney structural lesions was also examined in a subset of 111 participants. Of the 237 participants (mean age 42 years, diabetes duration 11 years, and GFR 153 mL/min and median urine albumin-to-creatinine ratio 36 mg/g), 69 progressed to ESKD during a median follow-up of 17.5 years. In latent class analysis, distinct trajectories characterized by increasing R A -to-R E ratio (HR 4.60, 95% CI 2.55-8.31) or elevated P GLO followed by a rapid decline (HR 2.96, 95% CI 1.45-6.02) strongly predicted incident ESKD. P GLO (R 2 5 21%, P < 0.0001) and R A -to-R E ratio (R 2 5 15%, P < 0.0001) also correlated with mesangial fractional volume, a structural predictor of DKD progression. In conclusion, intraglomerular hemodynamic parameters associated strongly with incident ESKD and correlated with structural lesions of DKD.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 98%

Intraglomerular Dysfunction Predicts Kidney Failure in Type 2 Diabetes

Saulnier

Looker²,

Mauer

et al. 2021

Diabetes

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“…by wave separation [ 34 , 35 ]. Ideally, in future trials differences in impedance of the fistula and non-fistula arm should be assessed by simultaneous recording of pressure and flow, like Collard et al did to assess intra-glomerular pressure [ 36 ]. The number of included patients was 53, but they were heterogeneous in terms of age, chronic heart failure and, as already discussed, atrial fibrillation, all of which may have an impact on pulse wave morphology [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

Oscillometric pulse wave analysis for detecting low flow arteriovenous fistula

et al. 2023

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Background Pulse wave analysis may be useful to assess fistula function. We aimed to prospectively evaluate if convenient oscillometric devices are applicable to detect flow below 500 ml/min in a real life clinical setting. Methods Pulse waves were recorded ambilaterally with the vicorder® device at the brachial artery in 53 patients on haemodialysis with native fistula. Primary variables consisted of the mean slope between the systolic maximum and the diacrotic notch (Slope2), the sum of the mean slopes in the four characteristic sections of pulse waves (Slope∑) and the amplitude of relative volumetric change in the measuring cuff at the upper arm (AMP). Fistula flow was measured with the use of duplex sonography using a standardized approach. Results Parameter values above or below the median indicated measurement at the non-fistula side, with sensitivities/specificities of 0.79/0.79 (p < 0.001) for Slope 2, 0.64/0.64 (p = 0.003) for Slope∑ and 0.81/0.81 (p < 0.001) for AMP if measurements at the fistula and non-fistula arm were considered. ROC-analyses of parameter values measured at the fistula to detect low flow demonstrated AUCs (with CI) of 0.652 (0.437–0.866, p = 0.167) for Slope2, 0.732 (0.566–0.899, p = 0.006) for Slope∑ and 0.775 (0.56–0.991, p = 0.012) for AMP. The point with maximal youden’s index was regarded as optimal cut-off, which corresponded to sensitivities and specificities of 0.8/0.56 for slope2, 0.86/ 0.56 for Slope∑ and 0.93/0.78 for AMP. Conclusion Functional surveillance with oscillometry is a promising clinical application to detect a low fistula flow. Among all investigated pulse wave parameters AMP revealed the highest diagnostic accuracy. Graphical Abstract

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“…For that, we used the Hagen-Poiseuille model with haematocrit, without and with backflow (Section S1.1, Section S1.2, respectively), a power law fluid model (Section S1.3) and the Carreau model (Section S1.4), which accounts for the non-Newtonian shear thinning behaviour of blood [67,70]. The radii, lengths, and impedances values used in this bifurcation are physiologically correct (Table S1), characteristic of a healthy kidney [40,[71][72][73]. The physical parameters for the Carreau and the power law models are from Bessonov et al [67] and Sochi [70], respectively.…”

Section: Effect Of the Fluid Model Assumption On A Single-node Asymme...mentioning

confidence: 99%

A Mathematical Model of Blood Loss during Renal Resection

Cowley,

Luo,

Stewart

et al. 2023

Fluids

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In 2021, approximately 51% of patients diagnosed with kidney tumors underwent surgical resections. One possible way to reduce complications from surgery is to minimise the associated blood loss, which, in the case of partial nephrectomy, is caused by the inadequate repair of branching arteries within the kidney cut during the tumor resection. The kidney vasculature is particularly complicated in nature, consisting of various interconnecting blood vessels and numerous bifurcation, trifurcation, tetrafurcation, and pentafurcation points. In this study, we present a mathematical lumped-parameter model of a whole kidney, assuming a non-Newtonian Carreau fluid, as a first approximation of estimating the blood loss arising from the cutting of single or multiple vessels. It shows that severing one or more blood vessels from the kidney vasculature results in a redistribution of the blood flow rates and pressures to the unaltered section of the kidney. The model can account for the change in the total impedance of the vascular network and considers a variety of multiple cuts. Calculating the blood loss for numerous combinations of arterial cuts allows us to identify the appropriate surgical protocols required to minimise blood loss during partial nephrectomy as well as enhance our understanding of perfusion and account for the possibility of cellular necrosis. This model may help renal surgeons during partial organ resection in assessing whether the remaining vascularisation is sufficient to support organ viability.

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Estimation of Intraglomerular Pressure Using Invasive Renal Arterial Pressure and Flow Velocity Measurements in Humans

Cited by 7 publications

References 48 publications

Intraglomerular Dysfunction Predicts Kidney Failure in Type 2 Diabetes

Intraglomerular Dysfunction Predicts Kidney Failure in Type 2 Diabetes

Oscillometric pulse wave analysis for detecting low flow arteriovenous fistula

A Mathematical Model of Blood Loss during Renal Resection

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