Functional Characteristics of Renovascular Hypertension

Stamey, Thomas A.; Nudelman, Irwin J.; Good, Paul H.; Schwentker, Frederic N.; Hendricks, Frederick

doi:10.1097/00005792-196112000-00002

Cited by 189 publications

(36 citation statements)

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“…16 The initial studies described significant reductions in RBF, GFR, urine volume, and sodium excretion in the stenotic kidney of a magnitude similar to those reported in this study. 16 Under these conditions we found that a single intravenous injection of furosemide induced percentage increases in RBF and GFR which were 40% and 36.8% respectively higher in the stenotic than the contralateral kidney. This lateralization of the effects of fuorsemide should be regarded as highly significant if one considers that, because of the existing differences of RBF, the stenotic kidney received much less furosemide than the contralateral kidney.…”

Section: Discussionsupporting

confidence: 79%

Effect of furosemide on renal function in the stenotic and contralateral kidneys of patients with renovascular hypertension.

Ruilope¹,

García-Robles²,

Sancho-Rof³

et al. 1983

Hypertension

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SUMMARY In a group of six patients diagnosed as having unilateral renovascular hypertension due to fibromuscular dysplasia, inulin glomerular filtration rate, (GFR) and PAH renal plasma flow, (RPF) clearances, urine flow (V), urine sodium (UV Nl ), potassium (UV K ), urinary excretion of prostaglandin E^ (UV reEj ), thromboxane B 2 (UV TxJ , 2 ), and 6-keto prostaglandin F la (UV^^) were measured in each kidney before and after the i.v. administration of furosemide (20 mg). The basal values of GFR, RPF, UV Ni , UVpc E ,, UV TlB ,, and UV 6 . krto . PCFla were lower (p < 0.01) in the stenotic kidney. Furosemide increased RPF 11 % and 50%, GFR 25% and 62%, and V 142% and 280% in the contralateral and stenotic kidney respectively. The increase of UV Na was similar in the two kidneys. In the stenotic kidney, both UVpcEj and UVj^^pcf^ increased significantly (p < 0.01) with furosemide while UV TlB , remained unchanged. Furosemide did not alter the rate of excretion of the three prostaglandins measured in the contralateral kidney. We conclude that furosemide significantly improves renal circulatory and excretory function of the stenotic kidney. Since prostaglandin excretions also increased, the vasodilatation in the stenotic kidney may be prostaglandin mediated. IT is known that the vasodilator action of furosemide in the normal kidney is mostly mediated by increased synthesis of prostaglandins, 1 " 4 which may also modulate the diuretic effects of furosemide. 4 Furosemide is currently used in patients with unilateral renovascular stenosis; however, it is not known whether its hemodynamic and diuretic effects are equally exerted or predominantly exerted in the stenotic kidney or in the contralateral kidney. Further, we have no knowledge about the changes induced by furosemide in prostaglandin synthesis in the stenotic and contralateral kidney. 56 In a recent survey of the literature, 7 there is convincing evidence supporting the notion that increased synthesis of prostaglandins is important inFrom the Departments of Nephrology and Endocrinology, 1st October and Ramon y Cajal Hospitals, Madrid, Spain, and from the Departments of Nephrology and Physiology, Mayo Clinic and Foundation, Rochester, Minnesota.Supported by Grant HL16496 from the National Institutes of Health, the National Heart, Lung and Blood Institute, and grants from the Mayo Foundation and the Spanish Ministry of Health (FIS Exp. 83/0575).Address for reprints: Dr. J.C. Romero, Department of Physiology, 9th Floor Guggenheim Building, Mayo Foundation, Rochester, Minnesota 55905. the maintenance of renal blood flow during the early phases of renovascular hypertension. However, in the chronic stages of hypertension, the role of prostaglandins has not been adequately explored. 7This study was undertaken to determine the effect of furosemide on renal hemodynamics, renal excretory function, and postaglandin excretion in both the stenotic apd contralateral kidneys of patients with renovascular hypertension. Materials and Methods Patient ProtocolThe study was co...

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Section: Discussionsupporting

confidence: 79%

Effect of furosemide on renal function in the stenotic and contralateral kidneys of patients with renovascular hypertension.

Ruilope¹,

García-Robles²,

Sancho-Rof³

et al. 1983

Hypertension

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“…Results of those studies indicate that reduction in delivered sodium in the urine confirms a hemodynamically significant renal arterial lesion to a functioning kidney that could respond favorably to renal revascularization. 4,33 Whether studies with BOLD MR will provide insight into the "salvageability" of poststenotic kidneys cannot be determined from the data presented here but merits further study. Recent concerns regarding the potential for gadolinium-based MR contrast to induce tissue sclerosis ("nephrogenic systemic fibrosis") 34 may limit the use of contrast-enhanced MR angiography alone for imaging the renal vasculature in subjects with severely reduced GFR.…”

Section: Discussionmentioning

confidence: 94%

The Use of Magnetic Resonance to Evaluate Tissue Oxygenation in Renal Artery Stenosis

Textor

Glockner

Lerman

et al. 2008

Journal of the American Society of Nephrology

155

114

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Vascular occlusive disease poses a threat to kidney viability, but whether the events leading to injury and eventual fibrosis actually entail reduced oxygenation and regional tissue ischemia is unknown. Answering this question has been difficult because of the lack of an adequate method to assess tissue oxygenation in humans. BOLD (blood oxygen-level-dependent) magnetic resonance imaging detects changes in tissue deoxyhemoglobin during maneuvers that affect oxygen consumption, therefore this technique was used to image and analyze cortical and medullary segments of 50 kidneys in 25 subjects undergoing magnetic resonance (MR) angiography to diagnose renal artery stenosis (RAS). Magnetic rate of relaxation (R2*) positively correlates with deoxyhemoglobin levels and was therefore used as a surrogate measure of tissue oxygenation. Furosemide was administered to examine the effect of inhibiting energy-dependent electrolyte transport on tissue oxygenation in subjects with renovascular disease. In 21 kidneys with normal nephrograms, administration of furosemide led to a 20% decrease in medullary R2* (P Ͻ 0.01) and an 11.2% decrease in cortical R2*. In normal-size kidneys downstream of high-grade renal arterial stenoses, R2* was elevated at baseline, but fell after furosemide. In contrast, atrophic kidneys beyond totally occluded renal arteries demonstrated low levels of R2* that did not change after furosemide. In kidneys with multiple arteries, localized renal artery stenoses produced focal elevations of R2*, suggesting areas of deoxyhemoglobin accumulation. These results suggest that BOLD MR coupled with a method to suppress tubular oxygen consumption can be used to evaluate regional tissue oxygenation in the human kidney affected by vascular occlusive disease.

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“…ANF blood samples were drawn from the renal veins and the femoral artery for determination of renal ANF extraction. On a separate day, steady-state infusions of para-aminohippurate (PAH) were established and ureters were separately cannulated for urine collections in order to determine renal plasma flow and creatinine clearance in triplicate (21).…”

Section: Methodsmentioning

confidence: 99%

Clearance of atrial natriuretic factor by lung, liver, and kidney in human subjects and the dog.

Rodeheffer²,

et al. 1989

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We determined human and canine plasma clearance of atrial natriuretic factor (ANF) by lung, liver, and kidney from arteriovenous differences in plasma ANF and measured organ plasma flow. Human subjects had lower plasma ANF concentrations in the pulmonary vein or the pulmonary capillary wedge position when compared with the pulmonary artery, and both sites yielded pulmonary ANF extraction ratios of 24%. Canine lung ANF extraction was 19±3% and pulmonary ANF clearance was 328±78 ml/min per m2 vs. 357±53 ml/min per mI in man. Hepatic plasma ANF clearance was 216±26 ml/ min with an extraction ratio of 30±3% in humans and 199±89 ml/min and 36±6% in the dog. Renal plasma ANF clearance in human subjects was 78±12 ml/min per kidney and correlated well with each kidney's creatinine clearance (r = 0.58, P < 0.05). The mean renal ANF extraction ratio was 35±4% in human subjects and 42±6% in the dog.These data quantitate the specific organ ANF clearances by lung, liver, and kidney in human subjects and in dogs and provide a rationale for elevated plasma ANF levels in cirrhosis, renal failure, and diseases accompanied by reduced perfusion of these organs. These findings support the conclusion that plasma ANF concentrations are dependent upon both the stimuli for ANF secretion as well as the specific organ clearances of ANF.

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Functional Characteristics of Renovascular Hypertension

Cited by 189 publications

References 0 publications

Effect of furosemide on renal function in the stenotic and contralateral kidneys of patients with renovascular hypertension.

Effect of furosemide on renal function in the stenotic and contralateral kidneys of patients with renovascular hypertension.

The Use of Magnetic Resonance to Evaluate Tissue Oxygenation in Renal Artery Stenosis

Clearance of atrial natriuretic factor by lung, liver, and kidney in human subjects and the dog.

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