ABSTRACT
INTRODUCTION: Lupus nephritis (LN) is known to be one of the most serious complications of SLE and it is a major predictor of poor prognosis. Despite the improvement in understanding the pathophysiology of lupus nephritis and greater improvement in diagnostic approaches, lupus nephritis patients have poorer outcomes. OBJECTIVES: Study the relation between renal resistive index (RRI) and renal function and histopathological parameters in lupus nephritis (LN) patients. Also to investigate the usefulness of RRI in predicting response to treatment. PATIENTS AND METHODS: This study included 126 patients who were split into two groups (group 1: 101 LN patients and group 2: 25 SLE patients without renal affection); and 100 healthy controls (group 3). The RRI was measured for all participants through a colored Doppler ultrasound examination. LN patients underwent renal biopsy and received their therapy and were followed up for 6 months. RESULTS: The RRI was significantly greater in the LN group (mean±SD; 0.64±0.07) than in SLE patients without nephritis (0.5884±0.04) (P<0.0001). The RRI was greater in LN class IV (P<0.0001). RRI significantly correlated with the chronicity index (r=0.704, P<0.0001), activity index (r=0.310, P=0.002), and serum creatinine (r=0.607, P<0.0001) and negatively correlated with eGFR (r=-0.719, P<0.0001). Almost eighty-five percent (84.8%) of LN patients responded to induction therapy. RRI was significantly greater in the nonresponder group (mean±SD, 0.73±0.02) than that in the responder group (0.63±.07) (P<0.0001). All non-responders to induction therapy while only 29.8% of responders had an RRI of Ë0.7. RRI, according to regression analysis was a significant predictor of response to treatment in LN patients. CONCLUSION: RRI was significantly greater in the LN group and significantly correlated with kidney function and histopathological parameters. RRI can predict response to induction therapy in LN patients.
Subject(s)
Lupus Nephritis , Renal Artery , Vascular Resistance , Humans , Lupus Nephritis/physiopathology , Lupus Nephritis/diagnostic imaging , Female , Male , Adult , Prognosis , Renal Artery/diagnostic imaging , Renal Artery/physiopathology , Young Adult , Kidney/physiopathology , Kidney/diagnostic imaging , Kidney/pathology , Middle AgedABSTRACT
Levamisole is an anthelmintic drug restricted to veterinary use but is currently detected as the most widely used cocaine cutting agent in European countries. Levamisole-adulterated cocaine has been linked to acute kidney injury, marked by a decrease in glomerular filtration rate, which involves reduced renal blood flow, but data on the alteration of renovascular response produced by levamisole are scarce. Renal arteries were isolated from healthy rabbits and used for isometric tension recording in organ baths and protein analysis. We provide evidence that depending on its concentration, levamisole modulates renovascular tone by acting as a non-selective α-adrenergic receptor blocker and down-regulates α1-adrenoceptor expression. Furthermore, levamisole impairs the endothelium-dependent relaxation induced by acetylcholine without modifying endothelial nitric oxide synthase (eNOS) expression. However, exposure to superoxide dismutase (SOD) partially prevents the impairment of ACh-induced relaxation by levamisole. This response is consistent with a down-regulation of SOD1 and an up-regulation of NADPH oxidase 4 (Nox4), suggesting that endothelial NO loss is due to increased local oxidative stress. Our findings demonstrate that levamisole can interfere with renal blood flow and the coordinated response to a vasodilator stimulus, which could worsen the deleterious consequences of cocaine use.
Subject(s)
Levamisole , Nitric Oxide , Renal Artery , Vasodilation , Animals , Levamisole/pharmacology , Levamisole/toxicity , Rabbits , Renal Artery/drug effects , Renal Artery/metabolism , Renal Artery/physiopathology , Nitric Oxide/metabolism , Vasodilation/drug effects , Male , Adrenergic alpha-1 Receptor Antagonists/pharmacology , Adrenergic alpha-1 Receptor Antagonists/toxicity , Nitric Oxide Synthase Type III/metabolism , Oxidative Stress/drug effects , Receptors, Adrenergic, alpha-1/metabolism , Receptors, Adrenergic, alpha-1/drug effects , Superoxide Dismutase/metabolism , NADPH Oxidase 4/metabolism , Dose-Response Relationship, Drug , Superoxide Dismutase-1/metabolism , Vasodilator Agents/pharmacologyABSTRACT
Randomized clinical trials failed to show additional benefit of renal artery stenting on top of medical therapy. Instead of writing an obituary on renal artery stenting, we try to explain these disappointing results. A transstenotic pressure gradient is needed to reduce renal perfusion and to activate the renin-angiotensin-aldosterone system. In only a minority of patients included in trials, a transstenotic pressure gradient is measured and reported. Like the coronary circulation, integration of physiological lesion assessment will allow to avoid stenting of non-significant lesions and select those patients that are most likely to benefit from renal artery stenting. Renal artery interventions are associated with peri-procedural complications. Contemporary techniques, including radial artery access, no-touch technique to engage the renal ostium and the use of embolic protection devices, will minimize procedural risk. Combining optimal patient selection and meticulous technique might lead to a netto clinical benefit when renal artery stenting is added to optimal medical therapy.
Subject(s)
Renal Artery Obstruction , Stents , Humans , Renal Artery Obstruction/physiopathology , Renal Artery Obstruction/therapy , Renal Artery Obstruction/diagnostic imaging , Renal Artery Obstruction/etiology , Treatment Outcome , Risk Factors , Renal Artery/physiopathology , Renal Artery/diagnostic imaging , Endovascular Procedures/adverse effects , Endovascular Procedures/instrumentation , Patient Selection , Clinical Decision-MakingABSTRACT
OBJECTIVES: Mercapto acetyl tri-glycine renogram (MAG3) scan has been the gold standard assessment of pediatric ureteropelvic junction obstruction (UPJO) but requires intravenous access and radiation exposure. While Doppler ultrasound measurements of resistive indices (RI) of the arcuate arteries have been proposed as an alternative assessment of obstruction, they have not been widely adopted in the pediatric population. We hypothesized that RI of the main renal artery (RA) is more strongly correlated with MAG3 findings than arcuate RI. METHODS: Pediatric patients with unilateral Society for Fetal Urology grade 3-4 hydronephrosis undergoing concomitant RUS and MAG3 were recruited. Doppler ultrasound peak systolic velocity (PSV); RI of bilateral RA at the origin, middle, and hilum; and RI of the superior, middle, and lower pole arcuate arteries were obtained. MAG3 differential renal function (DRF) and T½ were recorded. Differences in RI measurements (DRI) between the affected and normal kidney were calculated and compared with DRF and T½. RESULTS: 31 patients (median 4.6-month-old) were enrolled. Only RA RI at the origin differed between affected and normal kidneys (p < .001). DRI RA at the origin showed weak evidence for an association with MAG3 DRF < 40% (p .07). DRI was not associated with T½ > 20 minutes. CONCLUSION: There was weak evidence for an association between RA DRI at the origin and DRF but not with T½. These findings suggest that RA DRI may provide additional data in the evaluation of patients with UPJO to tailor the use of MAG3 and associated risk of radiation exposure to those patients most at risk for concomitant renal function impairment.
Subject(s)
Ultrasonography, Doppler , Ureteral Obstruction , Humans , Ureteral Obstruction/diagnostic imaging , Ureteral Obstruction/physiopathology , Female , Male , Infant , Ultrasonography, Doppler/methods , Renal Artery/diagnostic imaging , Renal Artery/physiopathology , Kidney Pelvis/diagnostic imaging , Kidney Pelvis/physiopathology , Child, Preschool , Vascular Resistance/physiology , Child , Prospective Studies , Reproducibility of Results , Hydronephrosis/diagnostic imaging , Hydronephrosis/physiopathology , Kidney/diagnostic imaging , Kidney/physiopathologyABSTRACT
The double-kiss mini-crush (DKMC) technique has been successfully deployed in the past for the treatment of complex coronary lesions even for left main lesions. Our case report consists of a proof-of-principle that the DKMC technique can be successfully translated as well to the field of complex renal artery lesions. Insightful thinking out-of-the "coronary" box in concert with skillful off-label application of coronary stenting procedures may open the gate for unprecedented opportunities for the treatment of difficult-to-tackle in-stent restenosis in the renal circulation.
Subject(s)
Recurrence , Renal Artery Obstruction , Stents , Humans , Renal Artery Obstruction/diagnostic imaging , Renal Artery Obstruction/therapy , Renal Artery Obstruction/physiopathology , Renal Artery Obstruction/etiology , Treatment Outcome , Male , Angioplasty, Balloon/instrumentation , Vascular Patency , Aged , Renal Artery/diagnostic imaging , Renal Artery/physiopathologyABSTRACT
Acute kidney injury (AKI) is a critical complication of sepsis. There is a continuous need to identify and validate biomarkers for early detection. Serum and urinary biomarkers have been investigated, such as neutrophil gelatinase associated lipocalin (NGAL) and cystatin C (Cys C), but their reliability in the intensive care unit (ICU) remains unknown. Renal hemodynamics can be investigated by measuring the renal resistive index (RRI). This study aimed to compare the performance of RRI, serum NGAL (sNGAL), urinary NGAL (uNGAL), and serum Cys C levels as early predictors of the diagnosis and persistence of sepsis-associated AKI. A total of 166 adult patients with sepsis syndrome were enrolled immediately after ICU admission. Biomarkers were measured directly (T1) and on day 3 (T3). RRI was measured directly (T1) and 24 h later (T2). Patients were categorized (according to the occurrence and persistence of AKI within the first 7 days) into three groups: no AKI, transient AKI, and persistent AKI. The incidence rate of sepsis-associated AKI was 60.2%. Sixty-six patients were categorized as in the no AKI group, while another 61 were in transient AKI and only 39 were in persistent AKI. The RRI value (T1 ≥ 0.72) was the best tool for predicting AKI diagnosis (area under the receiver operating characteristic curve, AUROC = 0.905). Cys C (T1 ≥ 15.1 mg/l) was the best tool to predict the persistence of AKI (AUROC = 0.977). RRI (T1) was the best predictive tool for sepsis-associated AKI, while Cys C was the best predictor of its persistence and 28-day mortality.
Subject(s)
Acute Kidney Injury , Biomarkers , Cystatin C , Lipocalin-2 , Sepsis , Humans , Acute Kidney Injury/etiology , Acute Kidney Injury/physiopathology , Biomarkers/blood , Biomarkers/analysis , Male , Female , Sepsis/complications , Sepsis/physiopathology , Middle Aged , Aged , Cystatin C/blood , Lipocalin-2/blood , Lipocalin-2/urine , Lipocalin-2/analysis , Predictive Value of Tests , Renal Artery/physiopathology , Renal Artery/diagnostic imaging , Prospective Studies , Intensive Care Units/statistics & numerical data , Intensive Care Units/organization & administration , ROC Curve , Early DiagnosisABSTRACT
BACKGROUND: Percutaneous-transluminal renal angioplasty (PTRA) and stenting aim to halt the progression of kidney disease in patients with renal artery stenosis (RAS), but its outcome is often suboptimal. We hypothesized that a model incorporating markers of renal function and oxygenation extracted using radiomics analysis of blood oxygenation-level dependent (BOLD)-MRI images may predict renal response to PTRA in swine RAS. MATERIALS AND METHODS: Twenty domestic pigs with RAS were scanned with CT and BOLD MRI before and 4 weeks after PTRA. Stenotic (STK) and contralateral (CLK) kidney volume, blood flow (RBF), and glomerular filtration rate (GFR) were determined, and BOLD-MRI R2 * maps were generated before and after administration of furosemide, a tubular reabsorption inhibitor. Radiomics features were extracted from pre-PTRA BOLD maps and Robust features were determined by Intraclass correlation coefficients (ICC). Prognostic models were developed to predict post-PTRA renal function based on the baseline functional and BOLD-radiomics features, using Lasso-regression for training, and testing with resampling. RESULTS: Twenty-six radiomics features passed the robustness test. STK oxygenation distribution pattern did not respond to furosemide, whereas in the CLK radiomics features sensitive to oxygenation heterogeneity declined. Radiomics-based model predictions of post-PTRA GFR (r = 0.58, p = 0.007) and RBF (r = 0.68; p = 0.001) correlated with actual measurements with sensitivity and specificity of 92% and 67%, respectively. Models were unsuccessful in predicting post-PTRA systemic measures of renal function. CONCLUSIONS: Several radiomics features are sensitive to cortical oxygenation patterns and permit estimation of post-PTRA renal function, thereby distinguishing subjects likely to respond to PTRA and stenting.
Subject(s)
Disease Models, Animal , Glomerular Filtration Rate , Magnetic Resonance Imaging , Predictive Value of Tests , Renal Artery Obstruction , Renal Circulation , Stents , Sus scrofa , Renal Artery Obstruction/physiopathology , Renal Artery Obstruction/diagnostic imaging , Renal Artery Obstruction/therapy , Animals , Oxygen/blood , Time Factors , Kidney Cortex/diagnostic imaging , Kidney Cortex/blood supply , Kidney Cortex/physiopathology , Kidney Cortex/metabolism , Furosemide/administration & dosage , Angioplasty, Balloon/instrumentation , Renal Artery/diagnostic imaging , Renal Artery/physiopathology , Female , Male , Diuretics , Image Interpretation, Computer-Assisted , Treatment Outcome , RadiomicsABSTRACT
OBJECTIVE: To investigate the value of renal artery resistance index (RRI) and urinary angiotensinogen (UAGT) in the early diagnosis of acute kidney injury (AKI) in patients with sepsis. METHODS: A prospective study was conducted. Seventy-eight patients with sepsis admitted to the department of critical care medicine of General Hospital of Ningxia Medical University from January to September 2021 were enrolled. Patients were observed for the development of AKI within 1 week. General data [gender, age, body mass index (BMI), major infection sites and critical illness related scores], laboratory indicators [mean arterial pressure (MAP), central venous pressure (CVP), procalcitonin (PCT), arterial blood lactic acid (Lac), etc.], duration of mechanical ventilation and length of intensive care unit (ICU) stay were recorded. After hemodynamic stabilization of the patients, renal ultrasound was performed to measure the RRI within 24 hours after ICU admission. Urine samples were taken immediately after diagnosis, and the level of UAGT was detected by enzyme-linked immunosorbent assay (ELISA). The above parameters were compared between the two groups. Multivariate Logistic regression was used to analyze the risk factors of AKI in patients with sepsis. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of related indicators for AKI in sepsis. RESULTS: A total of 78 patients were finally enrolled, of which 45 developed AKI and 33 did not. Compared with the non-AKI group, the rates of vasoactive drugs use, 28-day mortality, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score, PCT, Lac, RRI and UAGT were significantly higher in the AKI group [rates of vasoactive drugs use: 68.9% vs. 39.4%, 28-day mortality: 48.9% vs. 24.2%, SOFA score: 12.0 (10.5, 14.0) vs. 8.0 (7.0, 10.0), APACHE II score: 22.0 (18.0, 27.5) vs. 16.0 (15.0, 18.5), PCT (µg/L): 12.5±2.6 vs. 10.9±2.8, Lac (mmol/L): 2.6 (1.9, 3.4) vs. 1.9 (1.3, 2.6), RRI: 0.74±0.03 vs. 0.72±0.02, UAGT (µg/L): 75.16±19.99 vs. 46.28±20.75, all P < 0.05], the duration of mechanical ventilation and the length of ICU stay were significantly prolonged [duration of mechanical ventilation (days): 8.0 (7.0, 12.0) vs. 5.0 (4.0, 6.0), length of ICU stay (days): 14.0 (10.0, 16.0) vs. 9.0 (8.0, 11.5), both P < 0.01], and MAP was significantly lowered [mmHg (1 mmHg ≈ 0.133 kPa): 68.5±11.2 vs. 74.2±12.8, P < 0.05]. There was no significant difference in other parameters between the two groups. Multivariate Logistic regression analysis showed that SOFA score [odds ratio (OR) = 2.088, 95% confidence interval (95%CI) was 1.322-3.299], APACHE II score (OR = 1.447, 95%CI was 1.134-1.845), RRI (OR = 1.432, 95%CI was 1.103-1.859), and UAGT (OR = 1.077, 95%CI was 1.035-1.121) were independent risk factors for sepsis complicated with AKI (all P < 0.01). ROC curve analysis showed that SOFA score, APACHE II score, RRI and UAGT had certain predictive value for AKI in septic patients, the area under the ROC curve (AUC) were 0.814 (95%CI was 0.716-0.912), 0.804 (95%CI was 0.708-0.901), 0.789 (95%CI was 0.690-0.888), and 0.840 (95%CI was 0.747-0.934), respectively, and the AUC of RRI combined with UAGT was 0.912 (95%CI was 0.849-0.974), which was better than the above single index (all P < 0.05). CONCLUSIONS: RRI combined with UAGT has a high early predictive value for septic AKI.
Subject(s)
Acute Kidney Injury , Angiotensinogen , Renal Artery , Sepsis , Vascular Resistance , Humans , Acute Kidney Injury/diagnosis , Acute Kidney Injury/microbiology , Acute Kidney Injury/urine , Angiotensinogen/urine , Early Diagnosis , Intensive Care Units , Procalcitonin/blood , Prognosis , Prospective Studies , Renal Artery/physiopathology , Retrospective Studies , ROC Curve , Sepsis/complications , Sepsis/urineABSTRACT
Arachidonic acid (AA)-derived cytochrome P450 (CYP) derivatives, epoxyeicosatrienoic acids (EETs) and 20-hidroxyeicosatetranoic acid (20-HETE), play a key role in kidney tubular and vascular functions and blood pressure. Altered metabolism of CYP epoxygenases and CYP hydroxylases has differentially been involved in the pathogenesis of metabolic disease-associated vascular complications, although the mechanisms responsible for the vascular injury are unclear. The present study aimed to assess whether obesity-induced changes in CYP enzymes may contribute to oxidative stress and endothelial dysfunction in kidney preglomerular arteries. Endothelial function and reactive oxygen species (ROS) production were assessed in interlobar arteries of obese Zucker rats (OZR) and their lean counterparts lean Zucker rats (LZR) and the effects of CYP2C and CYP4A inhibitors sulfaphenazole and HET0016, respectively, were examined on the endothelium-dependent relaxations and O2- and H2O2 levels of preglomerular arteries. Non-nitric oxide (NO) non-prostanoid endothelium-derived hyperpolarization (EDH)-type responses were preserved but resistant to the CYP epoxygenase blocker sulfaphenazole in OZR in contrast to those in LZR. Sulfaphenazole did not further inhibit reduced arterial H2O2 levels, and CYP2C11/CYP2C23 enzymes were downregulated in intrarenal arteries from OZR. Renal EDH-mediated relaxations were preserved in obese rats by the enhanced activity and expression of endothelial calcium-activated potassium channels (KCa). CYP4A blockade restored impaired NO-mediated dilatation and inhibited augmented O2- production in kidney arteries from OZR. The current data demonstrate that both decreased endothelial CYP2C11/ CYP2C23-derived vasodilator H2O2 and augmented CYP4A-derived 20-HETE contribute to endothelial dysfunction and vascular oxidative stress in obesity. CYP4A inhibitors ameliorate arterial oxidative stress and restore endothelial function which suggests its therapeutic potential for the vascular complications of obesity-associated kidney injury.
Subject(s)
Cytochrome P-450 Enzyme System/metabolism , Endothelium, Vascular/metabolism , Kidney/metabolism , Obesity/metabolism , Oxidative Stress , Renal Artery/metabolism , Amidines/pharmacology , Animals , Aryl Hydrocarbon Hydroxylases/metabolism , Cytochrome P-450 CYP2J2/metabolism , Cytochrome P-450 CYP4A/metabolism , Cytochrome P450 Family 2/metabolism , Hydrogen Peroxide/metabolism , Hydroxyeicosatetraenoic Acids/antagonists & inhibitors , Hydroxyeicosatetraenoic Acids/metabolism , Kidney/blood supply , Male , Obesity/physiopathology , Rats, Zucker , Reactive Oxygen Species/metabolism , Renal Artery/drug effects , Renal Artery/physiopathology , Steroid 16-alpha-Hydroxylase/metabolism , Sulfaphenazole/pharmacology , Vasodilation/drug effectsABSTRACT
OBJECTIVE: The indication of percutaneous renal transluminal angioplasty (PTRA) in fibromuscular dysplasia (FMD) is mainly based on renal artery stenosis (RAS) due to atherosclerosis criteria, which are not specific to FMD. Consequently, the selection of patients who could benefit from this treatment and its effectiveness remain uncertain. The aims of this study were to: (1) report the effects of PTRA guided by trans-stenotic pressure measurements on hypertension 7 months after treatment; (2) assess the impact of pressure measurement to guide treatment efficacy in comparison to visual angiographic parameters; and (3) evaluate the reproducibility and accuracy of the stenosis measurement using a 4F catheter in comparison to a pressure guidewire. METHODS: This prospective multi-centric study analyzed 24 patients with hypertension with RAS due to FMD that required PTRA. Clinical, duplex ultrasound, and angiographic indices were collected, and patients were followed up for 7 months (±1 month). Angiographic indices were measured twice both by a pressure guidewire and a 4F catheter. Assessment of procedural and clinical success of angioplasty was performed for all patients. RESULTS: Twenty-three patients (96%) had procedural success (considered as a post-PTRA translesional systolic gradient ≤10 mmHg or reduced by at least 80%) with a significant decrease in the systolic gradient after angioplasty (26.50 mmHg; [interquartile range, 16.75-38.75] vs 0.00 [interquartile range, 0.00-2.00]; P < .01). Three patients (12%) had complications, including two renal artery dissections and one partial renal infarction. Twenty-one patients (88%) were clinical responders to angioplasty at follow-up. Visual stenosis assessment showed a poor correlation with systolic gradient measurement before and after PTRA (R from -0.05 to 0.41; P = 0.06-0.82). High correlations were found between pressure measurements made by a 4F catheter and guidewire (R from 0.64 to 0.89; P ≤ .003). CONCLUSIONS: In patients selected by clinical indicators and duplex ultrasound, reaching a translesional systolic gradient ≤10 mmHg or reduced by at least 80% after angioplasty, promotes a high success rate for PTRA in hypertension due to FMD RAS.
Subject(s)
Angioplasty, Balloon , Arterial Pressure , Fibromuscular Dysplasia/therapy , Hypertension, Renovascular/therapy , Renal Artery Obstruction/therapy , Renal Artery/physiopathology , Adult , Angioplasty, Balloon/adverse effects , Blood Pressure Determination/instrumentation , Computed Tomography Angiography , Female , Fibromuscular Dysplasia/complications , Fibromuscular Dysplasia/diagnosis , Fibromuscular Dysplasia/physiopathology , France , Humans , Hypertension, Renovascular/diagnosis , Hypertension, Renovascular/etiology , Hypertension, Renovascular/physiopathology , Male , Middle Aged , Multidetector Computed Tomography , Prospective Studies , Renal Artery/diagnostic imaging , Renal Artery Obstruction/diagnosis , Renal Artery Obstruction/etiology , Renal Artery Obstruction/physiopathology , Time Factors , Transducers, Pressure , Treatment Outcome , Ultrasonography, Doppler, Color , Vascular Access DevicesABSTRACT
The development of a paraanastomotic pseudoaneurysm is a serious complication after open prosthetic reconstruction of the aorta for occlusive or aneurysmal disease. Open repair of these lesions has previously been associated with high rates of morbidity and mortality. Endovascular repair may provide suitable treatment for proximal paraanastomotic aortic bypass graft pseudoaneurysms in patients who are poor candidates for open surgery. Bilateral renal artery coverage may be necessary to achieve adequate fixation and seal during life-threatening emergency cases of pseudoaneurysm rupture. Due to the infrequency of reported cases, the consequences of bilateral renal artery occlusion during these complex procedures are poorly understood. We present a case of a proximal paraanastomotic aortobifemoral bypass pseudoaneurysm rupture that was managed using endovascular repair with intentional coverage of both renal arteries. We also review the contemporary literature on endovascular management of paraanastomotic aneurysms and discuss the role of bilateral renal artery coverage in treating select patients with complex ruptured aortic pathology.
Subject(s)
Aneurysm, False/surgery , Aneurysm, Ruptured/surgery , Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Renal Artery/surgery , Aged, 80 and over , Aneurysm, False/diagnostic imaging , Aneurysm, False/etiology , Aneurysm, False/physiopathology , Aneurysm, Ruptured/diagnostic imaging , Aneurysm, Ruptured/etiology , Aneurysm, Ruptured/physiopathology , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/instrumentation , Endovascular Procedures/instrumentation , Female , Humans , Renal Artery/diagnostic imaging , Renal Artery/physiopathology , Stents , Treatment OutcomeABSTRACT
BACKGROUND: A honeycomb-like structure (HLS) is a rare abnormality characterized by a braid-like appearance. Angiograph and intravascular examination, including coherence tomography and intravascular ultrasound (IVUS), can further confirm the multiple intraluminal channels or honeycomb structure, which can also be described as looking like 'swiss cheese', a 'spider web' or a 'lotus root'. Previous studies have mostly reported this abnormality in coronary arteries, with a few cases in renal arteries. More information about the characteristics and development of HLS is needed. CASE PRESENTATION: A 69-year-old Han man with resistant hypertension received abdominal enhanced computerised tomography and was revealed to have left renal artery stenosis with the possibility of left renal infarction. Renal artery angiography confirmed a 95% stenosis located in the proximal segment of the left renal artery, and the middle segment was blurred with multi-channel-like blood flow. Further IVUS was performed and identified multiple channels surrounded by fibrous tissue. It was a rare case of HLS in the renal artery secondary to the thrombus, with organisation and recanalisation. Balloon dilatation and stent implantation at the proximal segment of the left renal artery were performed successfully. Blood pressure was well controlled after the procedure. CONCLUSIONS: The IVUS findings are helpful for forming interventional therapeutic strategies for HLS lesions in the renal artery.
Subject(s)
Angioplasty, Balloon , Hypertension, Renovascular/therapy , Renal Artery Obstruction/therapy , Renal Artery/abnormalities , Aged , Angiography , Angioplasty, Balloon/instrumentation , Humans , Hypertension, Renovascular/diagnosis , Hypertension, Renovascular/etiology , Hypertension, Renovascular/physiopathology , Male , Renal Artery/diagnostic imaging , Renal Artery/physiopathology , Renal Artery Obstruction/complications , Renal Artery Obstruction/diagnostic imaging , Renal Artery Obstruction/physiopathology , Stents , Treatment Outcome , Ultrasonography, InterventionalABSTRACT
Renovascular hypertension is a common cause of secondary hypertension. According to the epidemiological survey, the prevalence of renovascular hypertension accounts for 1-5% of the population with hypertension. Most of the cases are associated with atherosclerosis and Fibromuscular Dysplasia (FMD). Owing to the lack of standard treatment, they will eventually develop into chronic kidney disease, which significantly affects the patient's quality of life. Hypertension is considered a prerequisite for renal artery surgery; renal function research is used to guide the treatment of unilateral lesions because endovascular intervention can only slightly improve hypertension and renal function. We advocate open surgery for patients with congenital dysplasia of renal vascular hypertension, in which the most common surgical operations are aortorenal artery bypass, renal artery endarterectomy, and renal artery replantation. This paper reports a rare case of renovascular hypertension. The patient was a 13-year-old female, and the operation was risky and complicated. He was diagnosed with a congenital absence of the right renal artery. The right renal function was recovered, and the blood pressure was well controlled after the Aorta-Right Renal Artery Bypass.
Subject(s)
Blood Pressure , Hypertension, Renovascular/surgery , Renal Artery/surgery , Vascular Grafting , Vascular Malformations/surgery , Adolescent , Anastomosis, Surgical , Antihypertensive Agents/therapeutic use , Blood Pressure/drug effects , Female , Humans , Hypertension, Renovascular/diagnostic imaging , Hypertension, Renovascular/etiology , Hypertension, Renovascular/physiopathology , Renal Artery/abnormalities , Renal Artery/diagnostic imaging , Renal Artery/physiopathology , Treatment Outcome , Vascular Malformations/complications , Vascular Malformations/diagnostic imaging , Vascular Malformations/physiopathologyABSTRACT
Nutcracker syndrome refers to the compression of the left renal vein between the abdominal aorta and the superior mesenteric artery. The subsequent venous congestion of the left kidney, when symptomatic, could be associated with left flank pain, hematuria, varicocele, dyspareunia, dysmenorrhea, and proteinuria. Here we describe a 42-year-old female patient with simultaneous Dunbar syndrome and a rare variant of nutcracker syndrome in which the left renal vein (LRV) compression is secondary to the unusual path of the vein between the right renal artery and the proper hepatic artery. For both the nutcracker syndrome and the Dunbar syndrome, open approach by median mini-laparotomic access for transposition of LRV, and resection of the diaphragmatic pillars and arcuate ligament was attempted. During the intervention, due to anatomical issues, the LRV transposition was converted to endovascular stenting of the LRV, moreover the implanted stent was transfixed with an external non-absorbable suture to avoid migration. At the 12 months follow-up the patient was asymptomatic, and the duplex scan confirmed the patency of the celiac trunk without re-stenosis and a correct position of the LRV stent with no proximal or distal migration.
Subject(s)
Hepatic Artery , Median Arcuate Ligament Syndrome/complications , Renal Artery/abnormalities , Renal Nutcracker Syndrome/complications , Renal Veins/abnormalities , Adult , Endovascular Procedures/instrumentation , Female , Hepatic Artery/diagnostic imaging , Hepatic Artery/physiopathology , Humans , Median Arcuate Ligament Syndrome/diagnostic imaging , Median Arcuate Ligament Syndrome/physiopathology , Median Arcuate Ligament Syndrome/surgery , Renal Artery/diagnostic imaging , Renal Artery/physiopathology , Renal Nutcracker Syndrome/diagnostic imaging , Renal Nutcracker Syndrome/physiopathology , Renal Nutcracker Syndrome/surgery , Renal Veins/diagnostic imaging , Renal Veins/physiopathology , Renal Veins/surgery , Stents , Treatment Outcome , Vascular Patency , Vascular Surgical ProceduresABSTRACT
Renal sympathetic nerves contribute to renal excretory function during volume expansion. We hypothesized that intact renal innervation is required for excretion of a fluid/electrolyte load in hypertensive chronic kidney disease (CKD) and normotensive healthy settings. Blood pressure, kidney hemodynamic and excretory response to 180 min of isotonic saline loading (0.13 ml/kg/min) were examined in female normotensive (control) and hypertensive CKD sheep at 2 and 11 months after sham (control-intact, CKD-intact) or radiofrequency catheter-based RDN (control-RDN, CKD-RDN) procedure. Basal blood pressure was ~ 7 to 9 mmHg lower at 2, and 11 months in CKD-RDN compared with CKD-intact sheep. Saline loading did not alter glomerular filtration rate in any group. At 2 months, in response to saline loading, total urine and sodium excretion were ~ 40 to 50% less, in control-RDN and CKD-RDN than intact groups. At 11 months, the natriuretic and diuretic response to saline loading were similar between control-intact, control-RDN and CKD-intact groups but sodium excretion was ~ 42% less in CKD-RDN compared with CKD-intact at this time-point. These findings indicate that chronic withdrawal of basal renal sympathetic activity impairs fluid/electrolyte excretion during volume expansion. Clinically, a reduced ability to excrete a saline load following RDN may contribute to disturbances in body fluid balance in hypertensive CKD.
Subject(s)
Hypertension/surgery , Renal Artery/surgery , Renal Insufficiency, Chronic/surgery , Saline Solution/administration & dosage , Animals , Denervation , Disease Models, Animal , Female , Glomerular Filtration Rate/drug effects , Hypertension/physiopathology , Hypertension/urine , Natriuresis , Renal Artery/physiopathology , Renal Insufficiency, Chronic/physiopathology , Renal Insufficiency, Chronic/urine , Saline Solution/pharmacology , SheepABSTRACT
Arterial hypercapnia reduces renal perfusion. Beetroot juice (BRJ) increases nitric oxide bioavailability and may improve renal blood flow. We tested the hypothesis that acute consumption of BRJ attenuates both decreases in blood velocity and increases in vascular resistance in the renal and segmental arteries during acute hypercapnia. In fourteen healthy young adults, blood velocity and vascular resistance were measured with Doppler ultrasound in the renal and segmental arteries during five minutes of breathing a carbon dioxide gas mixture (CO2) before and three hours after consuming 500 mL of BRJ. There was no difference between pre- and post-BRJ consumption in the increase in the partial pressure of end-tidal CO2 during CO2 breathing (pre: +4 ± 1 mmHg; post: +4 ± 2 mmHg, p = 0.4281). Segmental artery blood velocity decreased during CO2 breathing in both pre- (by -1.8 ± 1.9 cm/s, p = 0.0193) and post-BRJ (by -2.1 ± 1.9 cm/s, p = 0.0079), but there were no differences between pre- and post-consumption (p = 0.7633). Segmental artery vascular resistance increased from room air baseline during CO2 at pre-BRJ consumption (by 0.4 ± 0.4 mmHg/cm/s, p = 0.0153) but not post-BRJ (p = 0.1336), with no differences between pre- and post-consumption (p = 0.7407). These findings indicate that BRJ consumption does not attenuate reductions in renal perfusion during acute mild hypercapnia in healthy young adults.
Subject(s)
Beta vulgaris , Fruit and Vegetable Juices , Hemodynamics/drug effects , Hypercapnia/physiopathology , Kidney/blood supply , Plant Roots , Adult , Arterial Pressure , Blood Flow Velocity/drug effects , Carbon Dioxide , Drinking/physiology , Female , Healthy Volunteers , Humans , Male , Renal Artery/physiopathology , Respiration/drug effects , Tidal Volume/drug effects , Ultrasonography, Doppler , Vascular Resistance/drug effectsABSTRACT
We aimed to determine the diagnostic accuracy of maternal renal vasculature Doppler ultrasound indices in the prediction of preeclampsia. A total of 40 pregnant women with a gestational age of more than 20 weeks were included and followed. The pregnant women underwent a Doppler ultrasound examination to measure the resistance index (RI) of the interlobar arteries of right and left kidneys and the renal interlobar vein impedance index (RIVI). Of the included women, 15 patients developed preeclampsia based on clinical and laboratory criteria. The renal vascular Doppler ultrasound indices were compared between the two groups. Then, using the Receiver Operating Characteristic (ROC) analysis, the diagnostic accuracy of interlobar artery RI and RIVI were investigated in the prediction of preeclampsia occurrence. RIVI values of right and left kidneys were significantly higher in the preeclampsia group compared to the normal pregnancy group. The left kidney interlobar artery RI at a cut-point of 0.59 had a sensitivity of 100% and a specificity of 40% (area under curve=0.7, P-0.03) in the prediction of preeclampsia. The RIVI of the left kidney (adjusted odds ratio=17.14, 95% CI = 3.46 to 47.28) was statistically significant in predicting preeclampsia (P-0.006). We found that, besides other routine methods, using Doppler ultrasound and measuring RIVI can be reliable in the prediction of preeclampsia.
Subject(s)
Kidney/blood supply , Kidney/diagnostic imaging , Pre-Eclampsia/diagnostic imaging , Pre-Eclampsia/diagnosis , Ultrasonography, Doppler , Adult , Electric Impedance , Female , Gestational Age , Humans , Kidney/physiopathology , Logistic Models , Pre-Eclampsia/physiopathology , Pregnancy , ROC Curve , Renal Artery/diagnostic imaging , Renal Artery/physiopathology , Vascular ResistanceABSTRACT
OBJECTIVES: In the ever-advancing era of endovascular thoracoabdominal aneurysm (TAAA) repair, understanding long-term patency of renovisceral reconstructions after open TAAA repair provides important benchmarks. METHODS: Institutional open TAAA repair patient data were queried. Patients dying during index admission or with incomplete operative detail were excluded. Visceral and renal reconstructions were categorized as bypass, incorporation into a proximal or distal beveled aortic anastomosis, inclusion button, Carrel patch, or hybrid stent along with endarterectomy/stent adjuncts. Axial imaging or angiography determined long-term patency. Vessel event was defined as new occlusion or reintervention after repair. Overall time-to-event analysis was performed as well as separate analyses for each vessel (celiac, superior mesenteric artery [SMA], right renal, left renal) by reconstruction type utilizing Kaplan-Meier methods. Log-rank testing was employed to compare reconstructive strategies. RESULTS: Over 28 years, 604 repairs (type I, 106 [18%]; type II, 73 [12%]; type III, 195 [32%]; and type IV, 230 [38%]) were identified. Follow-up (median, 500 days) was available in 410/570 (72%) celiac, 406/573 (71%) SMA, 379/532 (71.2%) right renal, and 370/515 (72%) left renal reconstructions. There were five celiac, one SMA, eight right renal, and 10 left renal events. No type of reconstruction or adjunct was significantly associated with event. Overall 5-year patency of all renal/visceral reconstructions was 94% (95% confidence interval, 90%-96%). Estimated 5-year patency of the celiac, SMA, left renal, and right renal were similar, and were 99%, 100%, 97%, and 96%, respectively (P = .09). CONCLUSIONS: Visceral and renal long-term patency after open TAAA repair is excellent regardless of reconstructive technique. No differences are appreciated even when target vessel disease is addressed at the time of reconstruction. These findings continue to substantiate the effective long-term durability of open TAAA repair and are particularly germane to the ongoing evolution of endovascular strategies.
Subject(s)
Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation , Plastic Surgery Procedures , Renal Artery/surgery , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/physiopathology , Blood Vessel Prosthesis Implantation/adverse effects , Humans , Postoperative Complications/therapy , Plastic Surgery Procedures/adverse effects , Renal Artery/diagnostic imaging , Renal Artery/physiopathology , Retreatment , Retrospective Studies , Time Factors , Treatment Outcome , Vascular PatencyABSTRACT
INTRODUCTION: The blood pressure (BP) response to arterial renal denervation (RDN) is variable. METHODS: This study examined the effectiveness of renal pelvic denervation (RPD) on BP, heart rate (HR), norepinephrine (NE), and histopathology in 42 swine. NE levels were measured immediately, 7, 14, 30, and 90 days after RPD. Intra-arterial BP and HR were measured throughout RPD and after 14 days in 5 swine. RESULTS: During the procedure, RPD immediately reduced systolic BP (-20.6 ± 18.3 mm Hg), diastolic BP (-6.0 ± 8.3 mm Hg), and HR (-5.4 ± 5.6 bpm), which remained decreased at follow-up. The porcine kidneys had a mean NE reduction of 76% directly post procedure and 60% after 7 days, 64% after 14 days, 57% after 30 days, and 65% after 90 days. Histopathological examination confirmed nerve ablation. CONCLUSIONS: These preliminary findings suggest that the renal pelvis nerve ablation is an encouraging target for RDN. Clinical trials are required to test the feasibility of RPD in human hypertension.
Subject(s)
Hypertension/surgery , Kidney Pelvis/blood supply , Renal Artery/innervation , Sympathectomy , Animals , Blood Pressure/physiology , Disease Models, Animal , Female , Heart Rate/physiology , Humans , Hypertension/blood , Hypertension/physiopathology , Kidney Pelvis/innervation , Kidney Pelvis/physiopathology , Renal Artery/physiopathology , SwineABSTRACT
[Figure: see text].