Differences in GFR and Tissue Oxygenation, and Interactions between Stenotic and Contralateral Kidneys in Unilateral Atherosclerotic Renovascular Disease

• Published in: Clinical journal of the American Society of Nephrology 2016-03, Vol.11 (3), p.458-469
• Main Authors: Herrmann, Sandra M S, Saad, Ahmed, Eirin, Alfonso, Woollard, John, Tang, Hui, McKusick, Michael A, Misra, Sanjay, Glockner, James F, Lerman, Lilach O, Textor, Stephen C
• Format: Article
• Language: English
• Subjects: Aged; Atherosclerosis - complications; Atherosclerosis - diagnosis; Atherosclerosis - physiopathology; Atherosclerosis - therapy; Biomarkers - blood; Cardiovascular Agents - therapeutic use; Cell Hypoxia; Chemokine CCL2 - blood; Endovascular Procedures - instrumentation; Female; Glomerular Filtration Rate; Humans; Inflammation Mediators - blood; Kidney - blood supply; Kidney - metabolism; Kidney - physiopathology; Lipocalin-2 - blood; Magnetic Resonance Imaging; Male; Middle Aged; Multidetector Computed Tomography; Original; Oxygen - metabolism; Recovery of Function; Renal Artery Obstruction - complications; Renal Artery Obstruction - diagnosis; Renal Artery Obstruction - physiopathology; Renal Artery Obstruction - therapy; Renal Circulation; Renin - blood; Stents; Time Factors; Treatment Outcome
• ISSN: 1555-9041; 1555-905X
• DOI: 10.2215/CJN.03620415

Atherosclerotic renal artery stenosis (ARAS) can reduce renal blood flow, tissue oxygenation, and GFR. In this study, we sought to examine associations between renal hemodynamics and tissue oxygenation with single-kidney function, pressor hormones, and inflammatory biomarkers in patients with unilateral ARAS undergoing medical therapy alone or stent revascularization. Nonrandomized inpatient studies were performed in patients with unilateral ARAS (>60% occlusion) before and 3 months after revascularization (n=10) or medical therapy (n=20) or patients with essential hypertension (n=32) under identical conditions. The primary study outcome was change in single-kidney GFR. Individual kidney hemodynamics and volume were measured using multidetector computed tomography. Tissue oxygenation (using R(2)* as a measure of deoxyhemoglobin) was determined by blood oxygen level-dependent magnetic resonance imaging at 3 T. Renal vein neutrophil gelatinase-associated lipocalin (NGAL), monocyte chemoattractant protein-1 (MCP-1), and plasma renin activity were measured. Total GFR did not change over 3 months in either group, but the stenotic kidney (STK) GFR rose over time in the stent compared with the medical group (+2.2[-1.8 to 10.5] versus -5.3[-7.3 to -0.3] ml/min; P=0.03). Contralateral kidney (CLK) GFR declined in the stent group (43.6±19.7 to 36.6±19.5 ml/min; P=0.03). Fractional tissue hypoxia fell in the STK (fraction R(2)* >30/s: 22.1%±20% versus 14.9%±18.3%; P