Measurement of kidney perfusion by magnetic resonance imaging: comparison of MRI with arterial spin labeling to para-aminohippuric acid plasma clearance in male subjects with metabolic syndrome

Ritt, Martin; Janka, Rolf; Schneider, Markus P.; Martirosian, Petros; Hornegger, Joachim; Bautz, W.; Uder, Michael; Schmieder, Roland E.

doi:10.1093/ndt/gfp639

Cited by 75 publications

(79 citation statements)

References 25 publications

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“…Therefore, repeated measurements can be obtained without dye-related risks to the patient. Previously, we compared MRI-ASL with para-aminohippuric acid plasma clearance (the gold standard of renal perfusion measurements) and found a close relationship (r=0.58; P,0.001), indicating that this technique can approximate kidney perfusion (3,4).…”

Section: Introductionmentioning

confidence: 82%

Vascular and Renal Hemodynamic Changes after Renal Denervation

Ott¹,

Janka

Schmid

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Renal denervation (RDN) has been shown to be effective in reducing BP in treatmentresistant hypertension. Measurement of the renal and sympathetic activity revealed a decrease in sympathetic drive to the kidney and small resistance vessels after RDN. However, the consequences on renal perfusion and renal vascular resistance (RVR), as well as central hemodynamics, are unknown.Design, setting, participants, & measurements Nineteen patients with treatment-resistant hypertension (office BP$140/90 mmHg, despite at least three antihypertensive drugs [including a diuretic], and diagnosis confirmed by 24-hour ambulatory BP monitoring) underwent RDN between January and October 2011. Renal perfusion and RVR were noninvasively assessed by magnetic resonance imaging with arterial spin labeling, and renal function was assessed by estimating GFR before (day 21), after (day +1), and again after 3 months of RDN. Central hemodynamics was assessed using pulse wave analysis at day 21 and after 6 months of RDN.

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Section: Introductionmentioning

confidence: 82%

Vascular and Renal Hemodynamic Changes after Renal Denervation

Ott¹,

Janka

Schmid

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…Transplanted kidneys often have lower perfusion than native kidneys, yet a severe decline could indicate ischemic injury and functional deterioration (7). A recent study showed that ASL is also promising for assessing renal perfusion in patients with metabolic syndrome and detecting hemodynamic responses to pharmacologic interventions (8).…”

Section: Aslmentioning

confidence: 99%

Renal Relevant Radiology

Ebrahimi

Textor

Lerman

2014

Clinical Journal of the American Society of Nephrology

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SummaryBecause of its noninvasive nature and provision of quantitative measures of a wide variety of physiologic parameters, functional magnetic resonance imaging (MRI) shows great potential for research and clinical applications. Over the past decade, application of functional MRI extended beyond detection of cerebral activity, and techniques for abdominal functional MRI evolved. Assessment of renal perfusion, glomerular filtration, interstitial diffusion, and parenchymal oxygenation turned this modality into an essential research and potentially diagnostic tool. Variations in many renal physiologic markers can be detected using functional MRI before morphologic changes become evident in anatomic magnetic resonance images. Moreover, the framework of functional MRI opened a window of opportunity to develop novel pathophysiologic markers. This article reviews applications of some well validated functional MRI techniques, including perfusion, diffusion-weighted imaging, and blood oxygen level-dependent MRI, as well as some emerging new techniques such as magnetic resonance elastography, which might evolve into clinically useful tools.

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“…ASL allows imaging of the renal arteries despite their complex orientation [56]. A fairly good correlation of ASL with P AH clearance has been reported [57] and some applications after ren al transpl antation or in renal artery stenosis [55,58] have been proposed. One of the main interests of ASL is its ability to draw parametric maps of relative perfusion (Figure 2) enabling clinicians to study geographical intra-organ diff erences in pe rfus ion as opposed to overall organ blood fl ow.…”

Section: Arterial Spin Labelingmentioning

confidence: 98%

Measurement of Kidney Perfusion in Critically Ill Patients

Schneider

Goodwin

Bellomo

2013

Annual Update in Intensive Care and Emergency Medicine 2013

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Acute kidney injury (AKI) is a major complication of critical illness [1] occurring in 30 to 40 % of all critically ill patients and in its sev ere form requires renal replacement therapy (RRT), in approximately 5 % of patients [2]. AKI has been s hown to be an independent predictor for mortality [3] and is associated with invasive therapy and substantial costs [4].Despite its impor tance, the pathoph ysiology of AKI is still poorly understood. AKI is most commonly associated with systemic diseases, such as septic shock, major surgery and cardiogenic shock [1], but a specifi c mechanism causing AKI to develop in specifi c patients can rarely be determined. Since the early description of an "acute uremia syndrome" in crush injury victims during World War II [5,6] and its association with histopathological fi ndings similar to those found in experimental renal artery ligation, ischemia or some form of alteration in renal blood fl ow has been thought to play a pivotal role in the pathogenesis of AKI. Th is paradigm that essentially all AKI in critically ill patients is the result of some form or degree of ischemia remains of continuing conceptual dominanc e to this day [7]. Despite such dominance, there are only very limited data supporting this concept. In a recent systematic review, Prowle et al. [8] highlighted the extraordinary fact that renal blood fl ow measurement, irrespective of the technique used, has only been reported in 46 critically ill patients (fi ve studies) within the last sixty years. Th us, our knowledge, understanding, and theoretical constructs regarding global renal perfu sion in critically ill patients with RRT-treated AKI (an estimated 5 % of all ICU admissions for a total of approximately a quarter of a million such patients each year in developed countries alone) is, like an inverted pyramid, based on extremely weak evidence.Furthermore, given the complex and heterogeneous nature of the renal vasculature, evaluating the fl ow in the main renal arteries (macrocirculation) might not provide suffi cient information to adequately understand perfusion alterations in complex diseases, such as septic or cardio genic shock. Indeed, some pathophysiological processes may be associated with increased global renal blood fl ow [9,10] despite loss of f un ction. In such instances, there is experimental evidence that, at least in sepsis, this phenomenon may be caused by intra-renal shunting [11]. Hence, correlation between macroscopic renal blood fl ow and function is far from linear. Th erefore, techniques allowing the study of microcircu latory parameters, such as cortico-med ullary perfusion ratio and regional tissue oxygenation measurement, and assessment of their relative change over time may be more valuable in increasing our understanding of the pathophysiology of AKI.In this state-of-the art review, we discuss the value, challenges, limitations, safety and feasibility of diff erent techniques for the measurement of kidney perfusion in critically ill patients. Th e advantages of each technique wi...

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Measurement of kidney perfusion by magnetic resonance imaging: comparison of MRI with arterial spin labeling to para-aminohippuric acid plasma clearance in male subjects with metabolic syndrome

Abstract: Perfusion measurement of a single coronal kidney slice by MRI-ASL is able to approximate kidney perfusion and to approximate changes in kidney perfusion due to pharmacological intervention.

Cited by 75 publications

References 25 publications

Vascular and Renal Hemodynamic Changes after Renal Denervation

Vascular and Renal Hemodynamic Changes after Renal Denervation

Renal Relevant Radiology

Measurement of Kidney Perfusion in Critically Ill Patients

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