Letter to the Editor regarding the article "Left ventricular assist devices: a kidney's perspective".
Letter to the Editor regarding the article "Left ventricular assist devices: a kidney's perspective".
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关于“左心室辅助装置：肾脏的视角”一文致编辑的信。
DOI：
10.1007/s10741-015-9504-9
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发表时间：
2015
影响因子：
4.6
通讯作者：
Cooper,TimothyK
中科院分区：
文献类型：
--
作者：
Cooper,TimothyK
To the Editors, I enjoyed the recent review on left ventricular assist devices (LVADs) and kidney function by Tromp et al.[1]. I would, however, like to clarify one point related to animal studies on continuous flow (cf) versus pulsatile flow (pf) LVADs. The authors state ‘‘Animal studies report proliferation of SMCs in the afferent arteriole in the renal cortex [2, 3] and perivascular tissue [3], but could not determine whether this change in morphology affected afferent arteriolar constriction and renal function. Infiltration of inflammatory cells in the renal cortical matrix has been observed, suggesting an immunologic mechanism for SMC hypertrophy [2]. Interestingly, reduced pulsatility may induce (severe) periarteritis in the kidneys, an observation not made in control animals supported by pf-devices.’’Ohnishi et al. do indeed report proliferation of smooth muscle cells in the renal afferent arterioles of goats implanted with cf-LVADs. Ootaki et al., on the other hand, do not report any changes to the afferent arterioles in six calves implanted with cf-LVADs. Rather, the lesions reported by Ootaki et al. were observed in medium arcuate and interlobular arteries at the corticomedullary junction. These medium artery findings were consistent with previously described renal medium arterial lesions in calves implanted with cf-LVADs as reported by Kihara et al.[4], and with pulmonary artery lesions more recently reported in calves with cf-RVADs [5]. This critical distinction on lesion location (and species) is germane because, while smooth muscle cell proliferation in the afferent arteriole is fully consistent with fine control of glomerular blood pressure, lesions in the arcuate and interlobular (and pulmonary) arteries of calves may represent something else entirely.We have recently published a large retrospective study describing lesions of the renal arcuate and radial arteries and pulmonary arteries in 56 calves, including those implanted with either pulsatile or non-pulsatile LVADs as well as unimplanted calves [6]. Lesions included both smooth muscle cell hyperplasia and inflammation. The common thread to these cases was the use of intravenous cephalosporin antibiotics, unrelated to pump design (or even presence). Characteristic pulmonary arterial lesions in calves receiving intravenous penicillin or cephalosporin antibiotics were originally described in studies by Majeski and Fitts [7], and appear to be a specific idiopathic reaction in cattle. Regrettably, neither Ootaki et al. nor Kihara et al. indicate whether the calves in their studies similarly received intravenous beta-lactam class antibiotics. It therefore remains to be seen the translatability of the arterial findings in the calf LVAD preclinical model to human patients. It should be noted that humans and sheep implanted with cf-LVADs do not appear to show any renal arterial lesions [8, 9].
