Distinct renal injury in early atherosclerosis and renovascular disease
Distinct renal injury in early atherosclerosis and renovascular disease
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DOI：
10.1161/01.cir.0000027105.02327.48
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发表时间：
2002-08-27
期刊：
影响因子：
37.8
通讯作者：
Lerman, LO
中科院分区：
文献类型：
--
作者：
Chade, AR;Rodriguez-Porcel, M;Lerman, LO
背景-与其他原因引起的肾动脉狭窄（RAS）相比，动脉粥样硬化性肾血管疾病可能加重肾功能恶化和缺血性肾病，但其潜在机制尚不清楚。本研究旨在验证以下假设：早期动脉粥样硬化和低灌注并发症可能对狭窄肾的功能和结构产生更大的早期有害影响。方法和结果-基线和血管活性激发时的局部肾血流动力学和功能在12周的正常（n = 7）或高胆固醇血症后，通过电子束计算机断层扫描在猪体内定量（乙酰胆碱或硝普钠）。（HC，n = 7）饮食、RAS（n = 6）或并发HC和相似程度的RAS（HC+RAS，n=7）。离体研究快速冷冻的肾组织。RAS狭窄组和HC+RAS组的基础皮质灌注和单肾肾小球滤过率（GFR）降低相似，但肾小管液重吸收仅在HC+RAS组明显受损。在实验组中，对激发的灌注反应也同样迟钝。刺激GFR在正常、HC和RAS中增加（分别为38.3 ± 3.6%、36.4 ± 7.6%和60.4 ± 9.3%，P
Background-Atherosclerotic renovascular disease may augment deterioration of renal function and ischemic nephropathy compared with other causes of renal artery stenosis (RAS), but the underlying mechanisms remain unclear. This study was designed to test the hypothesis that concurrent early atherosclerosis and hypoperfusion might have greater early deleterious effects on the function and structure of the stenotic kidney.Methods and Results-Regional renal hemodynamics and function at baseline and during vasoactive challenge (acetylcholine or sodium nitroprusside) were quantified in vivo in pigs by electron-beam computed tomography after a 12-week normal (n = 7) or hypercholesterolemic (HC, n = 7) diet, RAS (n = 6), or concurrent HC and a similar degree of RAS (HC+RAS, n=7). Flash-frozen renal tissue was studied ex vivo. Basal cortical perfusion and single-kidney glomerular filtration rate (GFR) were decreased similarly in the stenotic RAS and HC+RAS kidneys, but tubular fluid reabsorption was markedly impaired only in HC+RAS. Perfusion responses to challenge were similarly blunted in the experimental groups. Stimulated GFR increased in normal, HC, and RAS (38.3 +/- 3.6%, 36.4 +/- 7.6%, and 60.4 +/- 9.3%, respectively, P