title: Revascularization of swine renal artery stenosis improves renal function but not the changes in vascular structure.
abstract: Renal revascularization by percutaneous transluminal angioplasty improves blood pressure and stenotic kidney function in selected groups of patients, but the reversibility of intrarenal and microvascular remodeling remains unknown. Here, we tested the hypothesis that renal angioplasty improves the function and structure of renal microcirculation in experimental chronic renal artery stenosis. Stenotic kidney function, hemodynamics, and endothelial function were assessed in vivo in pigs after 10 weeks of unilateral renal artery stenosis. Renal microvascular remodeling, angiogenic pathways, and fibrosis were measured ex vivo. Angioplasty and stenting carried out 4 weeks before measurement decreased blood pressure, improved glomerular filtration rate, and improved microvascular endothelial function. It also promoted the expression of angiogenic factors and decreased renal apoptosis due to stenosis, compared with a sham intervention. The spatial density of renal microvessels, however, was partially improved after angioplasty. Renal blood flow was incompletely restored compared with the kidneys of sham-treated animals, as was interstitial fibrosis. Renal microvascular media-to-lumen ratio remained unchanged by angioplasty. Thus, our study shows that revascularization of a stenotic renal artery restores the glomerular filtration rate and renal endothelial function 4 weeks later. Renal hemodynamics and structure, however, are incompletely resolved.
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Frederic
authors.initials: F
authors.lastname: Favreau
authors.forename: Xiang-Yang
authors.initials: XY
authors.lastname: Zhu
authors.forename: James D
authors.initials: JD
authors.lastname: Krier
authors.forename: Jing
authors.initials: J
authors.lastname: Lin
authors.forename: Lizette
authors.initials: L
authors.lastname: Warner
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Textor
authors.forename: Lilach O
authors.initials: LO
authors.lastname: Lerman
mesh_terms: D000800:Angioplasty, Balloon / Q000295:instrumentation; D000818:Animals; D017209:Apoptosis; D001794:Blood Pressure; D002908:Chronic Disease; D004195:Disease Models, Animal; D005260:Female; D005355:Fibrosis; D005919:Glomerular Filtration Rate; D006978:Hypertension, Renovascular / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D007668:Kidney / Q000098:blood supply* / Q000473:pathology / Q000503:physiopathology; D008833:Microcirculation; D055806:Microvessels / Q000473:pathology / Q000503:physiopathology*; D020127:Recovery of Function; D012077:Renal Artery / Q000473:pathology / Q000503:physiopathology*; D012078:Renal Artery Obstruction / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D012079:Renal Circulation; D015607:Stents; D034421:Sus scrofa; D013997:Time Factors
references.citation: Vasc Med. 2008;13(2):141-56
references.pmid: 18593803
references.citation: Hypertension. 2001 Feb;37(2 Pt 2):541-6
references.pmid: 11230332
references.citation: Arterioscler Thromb Vasc Biol. 2004 Oct;24(10):1854-9
references.pmid: 15308558
references.citation: JACC Cardiovasc Interv. 2009 Mar;2(3):175-82
references.pmid: 19463422
references.citation: Am J Physiol Heart Circ Physiol. 2006 Jan;290(1):H107-18
references.pmid: 16126815
references.citation: Arterioscler Thromb Vasc Biol. 2003 Jul 1;23(7):1295-301
references.pmid: 12750121
references.citation: J Vasc Surg. 1998 Jul;28(1):167-77
references.pmid: 9685143
references.citation: Am J Hypertens. 2000 Nov;13(11):1210-7
references.pmid: 11078182
references.citation: Circulation. 2009 Feb 3;119(4):547-57
references.pmid: 19153272
references.citation: J Am Soc Nephrol. 2004 Aug;15(8):1974-82
references.pmid: 15284283
references.citation: Urol Clin North Am. 2001 Nov;28(4):793-803, ix
references.pmid: 11791495
references.citation: J Am Soc Nephrol. 2004 Apr;15(4):958-66
references.pmid: 15034098
references.citation: Radiology. 2007 May;243(2):405-12
references.pmid: 17456868
references.citation: Cardiovasc Res. 2000 May;46(2):286-97
references.pmid: 10773233
references.citation: Am J Physiol Renal Physiol. 2004 Jun;286(6):F1079-86
references.pmid: 14722019
references.citation: J Am Soc Nephrol. 1999 Jul;10(7):1455-65
references.pmid: 10405201
references.citation: J Am Soc Nephrol. 2004 Jul;15(7):1816-25
references.pmid: 15213269
references.citation: Am J Physiol. 1992 Aug;263(2 Pt 2):F251-5
references.pmid: 1324607
references.citation: Nat Rev Cancer. 2008 Dec;8(12):942-56
references.pmid: 19029957
references.citation: Circulation. 2005 Aug 30;112(9):1362-74
references.pmid: 16129817
references.citation: Circulation. 2004 May 4;109(17):2109-15
references.pmid: 15051643
references.citation: FASEB J. 2006 Aug;20(10):1706-8
references.pmid: 16790524
references.citation: Hypertension. 2008 Feb;51(2):466-73
references.pmid: 18172054
references.citation: N Engl J Med. 2002 Jun 20;346(25):1954-62
references.pmid: 12075056
references.citation: Circulation. 2002 Aug 27;106(9):1165-71
references.pmid: 12196346
references.citation: J Vasc Surg. 2002 Sep;36(3):443-51
references.pmid: 12218965
references.citation: Pharmacol Rev. 2000 Jun;52(2):237-68
references.pmid: 10835101
references.citation: Curr Opin Nephrol Hypertens. 2002 May;11(3):295-9
references.pmid: 11981259
references.citation: Eur J Vasc Endovasc Surg. 2002 Feb;23(2):146-52
references.pmid: 11863332
references.citation: Kidney Int. 2006 Feb;69(4):715-22
references.pmid: 16395249