Magnetic resonance measurements of renal blood flow and disease progression in autosomal dominant polycystic kidney disease.
Whether changes in renal blood flow (RBF) are associated with and possibly contribute to cystic disease progression in autosomal dominant polycystic kidney disease (ADPKD) has not been ascertained. The Consortium for Radiologic Imaging Studies of Polycystic Kidney Disease (CRISP) was created to develop imaging techniques and analyses to evaluate progression. A total of 131 participants with early ADPKD had measurements of RBF and total kidney (TKV) and cyst (TCV) volumes by magnetic resonance and of GFR by iothalamate clearance at baseline and 1, 2, and 3 yr. The effects of age, gender, body mass index, hypertension status, mean arterial pressure (MAP), TKV, TCV, RBF, renal vascular resistance (RVR), GFR, serum uric acid, HDL and LDL cholesterol, 24-h urine volume, sodium (UNaE) and albumin (UAE) excretions, and estimated protein intake were examined at baseline on TKV, TCV, and GFR slopes. TKV and TCV increased, RBF decreased, and GFR remained stable. TKV, TCV, RVR, serum uric acid, UAE, UNaE, age, body mass index, MAP, and estimated protein intake were positively and RBF and GFR negatively correlated with TKV and TCV slopes. TKV, RBF, UNaE, and UAE were independent predictors of TKV and TCV slopes (structural disease progression). TKV, TCV, RVR, and MAP were negatively and RBF positively correlated with GFR slopes. Regression to the mean confounded the analysis of GFR slopes. TKV and RBF were independent predictors of GFR decline (functional disease progression). In ADPKD, RBF reduction (1) parallels TKV increase, (2) precedes GFR decline, and (3) predicts structural and functional disease progression.
Torres
Vicente E
VE
Mayo Clinic College of Medicine, Rochester, MN 55901, USA. torres.vicente@mayo.edu
King
Bernard F
BF
Chapman
Arlene B
AB
Brummer
Marijn E
ME
Bae
Kyongtae T
KT
Glockner
James F
JF
Arya
Kraisthith
K
Risk
Dana
D
Felmlee
Joel P
JP
Grantham
Jared J
JJ
Guay-Woodford
Lisa M
LM
Bennett
William M
WM
Klahr
Saulo
S
Meyers
Catherine M
CM
Zhang
Xiaoling
X
Thompson
Paul A
PA
Miller
J Philip
JP
D000293:Adolescent; D000328:Adult; D001794:Blood Pressure; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000503:physiopathology; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016891:Polycystic Kidney, Autosomal Dominant / Q000473:pathology* / Q000503:physiopathology*; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012079:Renal Circulation