Hemodynamic Measurements for the Selection of Patients With Renal Artery Stenosis

Brussel, Peter M. van; Hoef, Tim P. van de; Winter, Robbert J. de; Vogt, Liffert; Born, Bert‐Jan H. van den

doi:10.1016/j.jcin.2017.02.046

Cited by 21 publications

(10 citation statements)

References 51 publications

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“…15 Direct assessment of renal hemodynamics using combined intrarenal pressure and flow velocity measurements may provide further insight in renal pathophysiology and serve as a benchmark for future noninvasive diagnostics in patients with CKD. 16,17 Recently, we have shown that measurement of intrarenal hyperemic flow velocity during dopamine-induced hyperemia is feasible and reproducible. 18 The renal circulation consists of afferent and efferent arteriolar systems, which can more or less independently influence GFR.…”

mentioning

confidence: 99%

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

Collard

Brussel

Velde

et al. 2020

JASN

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BackgroundGlomerular hyperfiltration resulting from an elevated intraglomerular pressure (Pglom) is an important cause of CKD, but there is no feasible method to directly assess Pglom in humans. We developed a model to estimate Pglom in patients from combined renal arterial pressure and flow measurements.MethodsWe performed hemodynamic measurements in 34 patients undergoing renal or cardiac angiography under baseline conditions and during hyperemia induced by intrarenal dopamine infusion (30 μg/kg). For each participant during baseline and hyperemia, we fitted an adapted three-element Windkessel model that consisted of characteristic impedance, compliance, afferent resistance, and Pglom.ResultsWe successfully analyzed data from 28 (82%) patients. Median age was 58 years (IQR, 52–65), median eGFR was 95 ml/min per 1.73 m2 (IQR, 74–100) using the CKD-EPI formula, 30% had microalbuminuria, and 32% had diabetes. The model showed a mean Pglom of 48.0 mm Hg (SD=10.1) at baseline. Under hyperemia, flow increased by 88% (95% CI, 68% to 111%). This resulted in a 165% (95% CI, 79% to 294%) increase in afferent compliance and a 13.1-mm Hg (95% CI, 10.0 to 16.3) decrease in Pglom. In multiple linear regression analysis, diabetes (coefficient, 10.1; 95% CI, 5.1 to 15.1), BMI (0.99 per kg/m2; 95% CI, 0.38 to 1.59), and renal perfusion pressure (0.42 per mm Hg; 95% CI, 0.25 to 0.59) were significantly positively associated with baseline Pglom.ConclusionsWe constructed a model on the basis of proximal renal arterial pressure and flow velocity measurements that provides an overall estimate of glomerular pressure and afferent and efferent resistance in humans. The model provides a novel research technique to evaluate the hemodynamics of CKD on the basis of direct pressure and flow measurements.Clinical Trial registry name and registration numberFunctional HEmodynamics in patients with and without Renal Artery stenosis (HERA), NL40795.018.12 at the Dutch national trial registry (toetsingonline.nl).

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confidence: 99%

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

Collard

Brussel

Velde

et al. 2020

JASN

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“…Variants of FFR have been used to assess the severity of renal artery stenosis as summarised in the review by van Brussel et al 51 . Their systematic review included 6 studies examining the efficacy of hyperaemic haemodynamic indices in guiding the therapeutic strategy on renal artery stenosis (the number of patients ranged from 17–62).…”

Section: Challenges and New Application Areasmentioning

confidence: 99%

CT-based fractional flow reserve: development and expanded application

Torii

Yacoub

2021

gcsp

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Computations of fractional flow reserve, based on CT coronary angiography and computational fluid dynamics (CT-based FFR) to assess the severity of coronary artery stenosis, was introduced around a decade ago and is now one of the most successful applications of computational fluid dynamic modelling in clinical practice. Although the mathematical modelling framework behind this approach and the clinical operational model vary, its clinical efficacy has been demonstrated well in general. In this review, technical elements behind CT-based FFR computation are summarised with some key assumptions and challenges. Examples of these challenges include the complexity of the model (such as blood viscosity and vessel wall compliance modelling), whose impact has been debated in the research. Efforts made to address the practical challenge of processing time are also reviewed. Then, further application areas – myocardial bridge, renal stenosis and lower limb stenosis – are discussed along with specific challenges expected in these areas.

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“…Этиология, патогенез не вызывают затруднений и давно уже выяснены. Известны риски, предрасполагающие факторы для развития атеросклероза в сосудах почек [1][2][3]. Тем не менее до сих пор нет единого систематизированного подхода в тактике ведения данных пациентов.…”

Section: обзор литературы введениеunclassified

Renal Artery Stenosis, Diagnosis and Management: a Literature Review

Idrisov

Хафизов

et al. 2021

Kreativnaâ hirurgiâ i onkologiâ

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Peripheral arterial atherosclerosis, i.a., in renal arteries, is quite a regular pathology. Despite long clear aetiology and pathogenesis, a unified systemic management approach in such patients is still lacking. We have reviewed and analysed classical academic resources and scientific record databases (Cochrane Library, PubMed and Google Scholar) in the topic and engaged self-experience on the observation and treatment of patients with stenotic peripheral arteries. Ultrasonic duplex scanning (USDS) of renal arteries is the most accessible and cost-effective screening method to date. Among non-invasive techniques are magnetic resonance imaging (MRI) and contrast-enhanced multislice computed tomography (MSCT). Subtraction angiography remains the gold standard for deciding a surgical treatment, and intravascular diagnostic capacities grow as well. Today’s interventional radiology is powered by fractional flow reserve (FFR) measurement, intravascular ultrasound (IVUS) and optical coherence tomography (OCT).The management of patients with narrowed renal arteries remains relevant and requires further insight. A continuing accumulation and synthesis of experience in diagnosis and treatment of peripheral arterial stenosis is imperative. Current medicine relies on high technologies in the discovery and treatment of peripheral arterial stenosis. The quality of patient management directly relates to the hospital technical and financial level, the personnel competence and mastery of current state-of-the-art.

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Hemodynamic Measurements for the Selection of Patients With Renal Artery Stenosis

Cited by 21 publications

References 51 publications

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

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

CT-based fractional flow reserve: development and expanded application

Renal Artery Stenosis, Diagnosis and Management: a Literature Review

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