Rationale and Objectives
To investigate the renal pressure-flow relationship and its relation to renin release,
because the renal perfusion pressure below which renal flow starts to decline and
renin secretion is upregulated is unclear.
Materials and Methods
A porcine model of graded unilateral renal artery stenosis was created. The severity
of the stenosis was expressed as the ratio between distal renal pressure (Pd) and aortic pressure (Pa). Pd and renal flow velocity were continuously measured using a combined pressure-flow
wire (Combowire®). Hemodynamic measurements and blood sampling for renin, angiotensin
and aldosterone were performed in baseline conditions and during progressive balloon
inflation in the renal artery leading to Pd decrease per 5% increment. Resistive index (RI) was computed as (1 − (End Diastolic
V/Peak Systolic V))*100.
Results
For a 5% decrease in renal perfusion pressure (95% of aortic pressure or 5% decrease
compared to Pa), peak systolic velocity started to decrease. A significant decrease in average peak
flow velocity was observed when distal renal perfusion pressure decreased by 25% and
was associated with activation of ipsilateral renin secretion. The RI decreased already
for minimal changes in Pd/Pa ratio.
Conclusion
In an animal model of unilateral graded renal artery stenosis, a 25% decrease in perfusion
pressure results in a significant decrease in distal renal flow, causing upregulation
of renin secretion.
Key Words
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References
- Renal-artery stenosis.N Engl J Med. 2001; 344: 431-442
- Prevalence of renovascular disease in the elderly: a population-based study.J Vasc Surg. 2002; 36: 443-451
- Renal artery stenosis and hypertension.Lancet. 1994; 344: 237-239
- Renovascular hypertension.Curr Opin Nephrol Hypertens. 1997; 6: 575-579
- Prevalence of atherosclerotic renal artery stenosis in patients with atherosclerosis elsewhere.Am J Med. 1990; 88: 46n-51n
- Renal artery stenosis: prevalence and associated risk factors in patients undergoing routine cardiac catheterization.J A Soc Nephrol. 1992; 2: 1608-1616
- Catheter-based therapy for atherosclerotic renal artery stenosis.Circulation. 2006; 113: 1464-1473
- Percutaneous revascularization of the renal arteries: predictors of outcome.J Vasc Interv Radiol. 2000; 11: 713-720
- Renal artery angioplasty: technical results and clinical outcome in 320 patients.Mayo Clin Proc. 1995; 70: 1041-1052
- Stent placement for renal arterial stenosis: where do we stand? A meta-analysis.Radiology. 2000; 216: 78-85
- Renal artery revascularization: updated meta-analysis with the CORAL trial.JAMA Intern Med. 2014; 174: 1849-1851
- Atheroemboli during renal artery angioplasty: an ex vivo study.J Vasc Surg. 2005; 41: 1026-1030
- Prognostic significance of small-artery structure in hypertension.Circulation. 2003; 108: 2230-2235
- Role of MDCT renal angiography in determining the anatomical eligibility for renal sympathetic denervation in resistant hypertensive patients.Egypt J Radiol Nucl Med. 2018; 49: 99-110
- Studies on experimental hypertension: I. The production of persistent elevation of systolic blood pressure by means of renal ischemia.J Exp Med. 1934; 59: 347-379
- Hemodynamic effects of arterial stenosis.Surgery. 1963; 53: 513-524
- Critical degree of renal arterial stenosis that causes hypertension in dogs.Angiology. 1992; 43: 833-842
- Coronary pressure-function and steady-state pressure-flow relations during autoregulation in the unanesthetized dog.Circ Res. 1988; 63: 821-836
- Physiologic basis for assessing critical coronary stenosis: instantaneous flow response and regional distribution during coronary hyperemia as measures of coronary flow reserve.Am J Cardiol. 1974; 33: 87-94
- Pressure-flow characteristics of coronary stenoses in unsedated dogs at rest and during coronary vasodilation.Circ Res. 1978; 43: 242-253
- Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses.New Engl J Med. 1996; 334: 1703-1708
- Guide for the care and use of laboratory animals. National Academies Press (US) Copyright 1996 by the National Academy of Sciences. All rights reserved, Washington (DC)1996
- Interpretation of renal angiography by radiologists.J Hypertens. 1999; 17: 1737-1741
- Usefulness of translesional pressure gradient and pharmacological provocation for the assessment of intermediate renal artery disease.Catheter Cardiovasc Interv. 2006; 68: 429-434
- Assessment of renal artery stenosis severity by pressure gradient measurements.J Am Coll Cardiol. 2006; 48: 1851-1855
- Primary hyperaldosteronism.Ann Clin Biochem. 2003; 40: 439-452
- Renin: friend or foe?.Heart (Br Card Soc). 2007; 93: 1026-1033
- Use of Doppler ultrasonography to predict the outcome of therapy for renal-artery stenosis.N Engl J Med. 2001; 344: 410-417
- Predictors of improved renal function after percutaneous stent-supported angioplasty of severe atherosclerotic ostial renal artery stenosis.Circulation. 2003; 108: 2244-2249
- Severity of renal artery lesions in patients enrolled into the CORAL trial.J Vasc Interv Radiol. 2010; 21: S19
- Assessment of renal artery stenosis: side-by-side comparison of angiography and duplex ultrasound with pressure gradient measurements.Eur Heart J. 2008; 29: 517-524
- Fractional flow reserve versus angiography for guiding percutaneous coronary intervention.N Engl J Med. 2009; 360: 213-224
- Evolving concepts of angiogram: fractional flow reserve discordances in 4000 coronary stenoses.Eur Heart J. 2014; 35: 2831-2838
- Fractional flow reserve–guided PCI versus medical therapy in stable coronary disease.N Engl J Med. 2012; 367: 991-1001
- Fractional flow reserve–guided PCI for stable coronary artery disease.N Engl J Med. 2014; 371: 1208-1217
- 2018 ESC/EACTS guidelines on myocardial revascularization.Eur Heart J. 2019; 40: 87-165
- The natural history of atherosclerotic and fibrous renal artery disease.Urol Clin North Am. 1984; 11: 383-392
- Natural history of atherosclerotic renal artery stenosis: a prospective study with duplex ultrasonography.J Vasc Surg. 1994; 19 (discussion 7–8): 250-257
Article info
Publication history
Published online: April 27, 2023
Accepted:
March 23,
2023
Received in revised form:
March 20,
2023
Received:
December 4,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved All rights reserved.
