Decrease of Glomerular Filtration Rate may be Attributed to the Microcirculation Damage in Renal Artery Stenosis
- Author:
- No author available
- Journal Title:
- Chinese Medical Journal
- Issue:
- 6
- DOI:
- 10.4103/0366-6999.152483
- Key Word:
- Glomerular Filtration Rate;Renal Artery Stenosis;Renal Microcirculation
Abstract： Background:The decrease of glomerular filtration rate has been theoretically supposed to be the result of low perfusion in renal artery stenosis (RAS).But the gap between artery stenosis and the glomerular filtration ability is still unclear.Methods:Patients with selective renal artery angiogram were divided by the degree of renal artery narrowing,level of estimated glomerular filtration rate (eGFR),respectively.The different levels of eGFR,renal microcirculation markers,and RAS severity were compared with each other,to determine the relationships among them.Results:A total of 215 consecutive patients were enrolled in the prospective cohort study.Concentrations of microcirculation markers had no significant difference between RAS group (RAS ≥ 50％) and no RAS group (RAS ＜ 50％) or did not change correspondingly to RAS severity.The value of eGFR in RAS group was lower than that in the no RAS group,but it did not decline parallel to the progressive severity of RAS.The microcirculation markers presented integral difference if grouped by different eGFR level with negative tendency,especially that plasma cystatin C (cysC) and urinary microalbumin to creatinine ratio (mACR) increased with the deterioration of eGFR,with strong (r =-0.713,P ＜ 0.001) and moderate (r =-0.580,P ＜ 0.001) correlations.In the subgroup analysis of severe RAS (RAS ≥ 80％),the levels of plasma cysC and urinary mACR demonstrated stronger negative associations with eGFR,(r =-0.827,P ＜ 0.001) and (r =-0.672,P ＜ 0.001) correlations,respectively.Conclusions:Severity of RAS could not accurately predict the value of eGFR,whereas microcirculation impairment may substantially contribute to the glomerular filtration loss in patients with RAS.
- [1]裴芳,李小鹰,方颖,等.老年原发性高血压左心室肥厚患者心肾微动脉的病理特征[J].2008,(10).
- [2]Textor,S.C.,Lerman,L.O..Reality and renovascular disease: When does renal artery stenosis warrant revascularization?[J].2014,63(2).
- [3]P A, Svendsen,B, Oxenb?ll,J S, Christiansen.Microalbuminuria in diabetic patients--a longitudinal study.[J].1981,242.
- [4]Liesbeth, Bax,Arend-Jan J, Woittiez,Hans J, Kouwenberg,etc.Stent placement in patients with atherosclerotic renal artery stenosis and impaired renal function: a randomized trial.[J].2009,150.
- [5]Victor H, Urbieta-Caceres,Farhan A, Syed,Jing, Lin,etc.Age-dependent renal cortical microvascular loss in female mice.[J].2012,302(8).
- [6]Alex, Bobik.The structural basis of hypertension: vascular remodelling, rarefaction and angiogenesis/arteriogenesis.[J].2005,23.
- [7]Christopher P, Price,Ronald G, Newall,James C, Boyd.Use of protein:creatinine ratio measurements on random urine samples for prediction of significant proteinuria: a systematic review.[J].2005,51.
- [8]M. E. Stromski,H. R. Brady,S. R. Gullans,etc.Application of missing pulse steady state free precession to the study of renal microcirculation[J].1991,20(1).
- [9]Truong L,Johnson RJ,Kang DH,etc.Role of the microvascular endothelium in progressive renal disease.[J].2002,13(3).
- [10]Bernard De Bruyne,Ganesh Manoharan,Nico H.J. Pijls,etc.Assessment of Renal Artery Stenosis Severity by Pressure Gradient Measurements[J].2006,48(9).
- [11]Dworkin LD,Murphy T.Is there any reason to stent atherosclerotic renal artery stenosis?[J].2010,56(2).
- [12]Alfonso, Eirin,Xiang-Yang, Zhu,Victor H, Urbieta-Caceres,etc.Persistent kidney dysfunction in swine renal artery stenosis correlates with outer cortical microvascular remodeling.[J].2011,300(6).
- [13]R L, Prewitt,I I, Chen,R, Dowell.Development of microvascular rarefaction in the spontaneously hypertensive rat.[J].1982,243.
- [14]Alejandro R, Chade.Renal vascular structure and rarefaction.[J].2013,3(2).
- [15]Dieter RS.The functional assessment of renal artery stenosis.[J].2005,3(3).
- [16]Cooper,C.J.,Murphy,T.P.,Cutlip,D.E.,etc.Stenting and medical therapy for atherosclerotic renal-artery stenosis[J].2014,370(1).
- [17]Lao,D.,Parasher,P.S.,Cho,K.C.,etc.Atherosclerotic renal artery stenosis - Diagnosis and treatment[J].2011,86(7).
- [18]Laohareungpanya N,Chaisuriya P,Futrakul N,etc.A defective angiogenesis in chronic kidney disease.[J].2008,30(2).
- [19]Lambers Heerspink HJ,Gansevoort RT,Brenner BM,etc.Comparison of different measures of urinary protein excretion for prediction of renal events.[J].2010,21(8).
- [20]Basile DP.Rarefaction of peritubular capillaries following ischemic acute renal failure: a potential factor predisposing to progressive nephropathy.[J].2004,13(1).