Medullary blood flow responses to changes in arterial pressure in canine kidney

Although it is well recognized that whole kidney and cortical blood flow exhibit efficient autoregulation in response to alterations in renal arterial pressure (RAP), the autoregulatory behavior of medullary blood flow (MBF) has remained uncertain. We have evaluated MBF responses to stepwise reductions in RAP for both short-term (2 min, n = 6) and longer periods (15 min, n = 7) using single-fiber laser-Doppler flowmetry with needle probes inserted into the mid-medullary region in denervated kidneys of 13 anesthetized dogs. The changes in cortical blood flow (CBF) were assessed with either a surface probe or a needle probe inserted into the cortex. Control total renal blood flow (RBF), assessed by electromagnetic flow probe in these dogs, was 5.2 +/- 0.3 ml.min-1.g-1, and glomerular filtration rate was 0.97 +/- 0.05 ml.min-1.g-1 (n = 7). RBF, MBF, and CBF all exhibited efficient autoregulatory behavior during changes in RAP from 150 to 75 mmHg. The slopes of RAP vs. RBF, CBF, as well as MBF, were not significantly different from zero within this range of RAP. Below RAP of 75 mmHg, all indexes of blood flow showed linear decreases with reductions in pressure. The data indicate that blood flow in the renal medulla of dogs exhibits efficient autoregulatory behavior, similar to that in the cortex.

MR perfusion imaging of the kidney pre- and post-dipyridamole stress

Animal studies have demonstrated that renal MR contrast enhancement depends on the timing of image acquisition. Limited human studies have demonstrated effects of dipyridamole (DP) on total renal perfusion. This study assessed the effect of DP on total and regional renal perfusion using gated perfusion MRI for patients undergoing DP stress. Five subjects with no evidence of renal ischemia were examined at rest and after DP stress. Rest MRI images in the left kidney were acquired using electrocardiogram (ECG)-gated MR: turbo fast low-angle shot (FLASH); echo time (TE) = 12, repetition time (TR) = 6, flip angle = 12, inversion time (TI) = 100) 10 to 45 seconds after injection of gadopentetate dimeglumine. Stress was induced in the MRI scanner (DP, .56 mg/kg over 4 minutes) followed by stress MRI after a second bolus of gadopentetate dimeglumine in the same position and identical time intervals. MR signal in the whole left kidney and renal medulla and cortex pre- and post-DP demonstrated a 70% depression of total renal perfusion with relative preservation of cortical perfusion at the expense of medullary perfusion. Post-DP MR images demonstrated a decrease in cortical perfusion with an additional 29% depression of medullary perfusion (P < .001) with respect to cortical perfusion. Turbo FLASH MRI can provide adequate time and spatial resolution to demonstrate changes in renal perfusion. Depression of renal medullary perfusion after DP appears to be caused by the intrarenal effect of DP and may have clinical impact.

Effects of contrast media and mannitol on renal medullary blood flow and red cell aggregation in the rat kidney

Hemodynamic factors may play a role in the development of acute renal failure following administration of contrast media (CM). In this study the effect of intravenous injection of contrast media and mannitol on red blood cell velocity (VRBC) and red blood cell aggregation in renal medullary vessels was studied in 58 rats. Renal medullary blood flow was investigated by a cross-correlation technique and by a visual aggregation score. The CM, namely diatrizoate, iopromide, iohexol, ioxaglate, iotrolan, were given in iodine equivalent doses (1600 mg/kg body wt). Mannitol (950 mOsm/liter) and Ringer's solution were used as controls. The same vessels were studied 30 minutes before and 30 minutes after injections. VRBC decreased significantly after injection of diatrizoate, iopromide, iohexol, iotrolan and mannitol. Ringer's solution and ioxaglate did not significantly alter medullary blood flow, while iotrolan and mannitol caused the largest decreases in VRBC. All CM and mannitol caused both red cell aggregation and cessation of blood flow. The decrease in blood flow and increase in red blood cell aggregation after injection of CM and mannitol may partly explain the occurrence of contrast medium-induced acute renal failure.

Hypertension from carotid occlusion decreases renal papillary plasma flow, hypotension from hemorrhage increases it, an autoregulatory paradox

Renal papillary plasma flow was tested during acute increases and decreases of perfusion pressure using the 125I-labelled albumin technique. Increases of pressure were attained through ligation of carotid arteries; decreases of pressure through modest hemorrhage. In 12 control rats with blood pressure of 144 mmHg, the papillary plasma flow averaged 21.5 ml per 100 g papilla per min. In 12 rats after ligation of carotid arteries, blood pressure rose from 143 mmHg to 172, a 20% increase. The papillary plasma flow in these rats with acute hypertension averaged 17.9 ml per 100 g papilla per min, a 17% decrease (p < 0.025). In another 12 rats after bleeding 1% of body weight over a period of 10 min, blood pressure dropped from 146 mmHg to 104, a 29% decrease. The papillary plasma flow in these rats with acute hypotension averaged 26.0 ml per 100g papilla per min, a 21% increase (p < 0.025). The decrease in papillary plasma flow during acute hypertension strongly suggests an increased vascular resistance of the descending vasa recta, while the increase in papillary plasma flow during acute hypotension suggests that vasodilatation occurred in these vessels. This dilatation may be produced by the local release of prostaglandins or other vasoactive substances. Thus, the renal papilla appears to "overshoot" its autoregulation of plasma flow, with actual reduced flow during an acute blood pressure rise and increased flow during an acute blood pressure fall, an enigmatic over-compensation.

Endothelial Ca2+ in afferent arterioles during myogenic activity

We measured endothelial Ca2+ concentration ([Ca2+]) in juxtamedullary afferent arterioles in response to step changes in perfusion pressure. Measurements were made with fura 2 using a fluorescence-imaging system designed to measure Ca2+ in whole tissues and minimize potentially harmful effects of ultraviolet illumination. The system yielded the typical sigmoidal relationship between fluorescence-emission ratio and [Ca2+] in vitro and was sensitive to endothelial Ca2+ transients elicited by bradykinin. Our goal was to determine whether changes in endothelial Ca2+ trigger events that cause myogenic vasoconstriction. Bradykinin, acting via endothelial cells, and sodium nitroprusside (SNP), acting independently, triggered vasodilation; bradykinin but not SNP increased endothelial Ca2+. Increased perfusion pressure caused vasoconstriction and a modest rise in endothelial Ca2+. Because the rise in Ca2+ with bradykinin initiates the vasodilation, the small rise in Ca2+ with pressure cannot cause vasoconstriction. Our results suggest that myogenic constriction is triggered from within vascular smooth muscle cells and that some other phenomenon, most likely increased shear stress, increases endothelial Ca2+ and modulates the myogenic reaction.

The role of medullary ischemia in acute renal failure

The introduction of new techniques for the determination of renal parenchymal oxygenation and intrarenal microcirculation has elucidated some important aspects in the pathophysiology of acute renal failure (ARF). Data accumulated over the last decade with these techniques, together with improved morphologic evaluation of the kidney, indicate that medullary damage may play a pivotal role in various forms of acute and chronic renal hypoxic and toxic insults. The outer medulla functions normally under hypoxic conditions, as a result of limited regional oxygen supply and high oxygen consumption for urinary concentration. Outer medullary oxygenation is critically balanced by mechanisms designed to adjust oxygen demand and supply, and their insufficiency may lead to ARF with hypoxic medullary damage. In this article, we outline our current concept of the physiologic control of medullary oxygenation and review the clinical conditions that predispose to hypoxic medullary damage, including rhabdomyolysis, hypercalcemia, or the exposure to endotoxin, nonsteroidal anti-inflammatory drugs, radiologic contrast agents, cyclosporine, FK506, and amphothericin. We shall indicate a possible role for medullary oxygen insufficiency in clinical conditions known to predispose to ARF, such as preexisting renal disease, diabetes mellitus, hypertension, atherosclerosis, effective volume depletion, urinary obstruction, or aging, and suggest potential strategies to preserve medullary oxygenation and integrity.

Dopamine increases renal medullary blood flow without improving regional hypoxia

The effects of dopamine (10 micrograms/kg/min i.v.) upon intrarenal microcirculation, total, superficial cortical and outer medullary blood flows and outer medullary pO2 were continuously determined in anesthetized rats with ultrasonic and laser-Doppler probes and oxygen microelectrodes. While total and cortical flows were unaffected, outer medullary flow increased by 35 +/- 5% (mean +/- SE, p < 0.01). Outer medullary pO2 was not significantly altered (from 16 +/- 4 to 18 +/- 4 mm Hg). In volume-expanded rats total and cortical flows rose as well. In rats pretreated with indomethacin, with or without N omega-nitro-L-arginine methyl ester HCl, dopamine restored renal microcirculation and ameliorated outer medullary hypoxia.

Noninvasive measurement of intrarenal blood flow distribution: kinetic model of renal 123I-hippuran handling

A new technique for noninvasive measurement of intrarenal blood flow distribution over cortex and medulla is proposed. The technique involves analysis of 123I-labeled hippuran renography, according to a kinetic model that describes the flow of 123I-hippuran from the heart (input) through the renal cortex and medulla to the bladder (output). The method is validated and compared with the standard microsphere injection technique in anesthetized dogs. Changes in intrarenal blood flow distribution were induced by infusion of placebo (n = 6), angiotensin I (n = 5), or atrial natriuretic factor (n = 5). Baseline percentage medullary blood flow in the left kidney was 12 +/- 1% of total renal blood flow measured with microspheres and 15 +/- 1% with renography. During infusion of the placebo, medullary blood flow decreased slightly compared with baseline, as measured with both methods, by 2 +/- 6 (microspheres) and 1 +/- 8% (renography). Infusion of angiotensin I caused a marked fall in medullary blood flow by 42 +/- 11 (microspheres) and 57 +/- 8% (renography). In contrast, infusion of atrial natriuretic factor caused a small rise in medullary blood flow as measured with both methods (9 +/- 3 and 12 +/- 11%, respectively). The absolute and percent changes in medullary blood flow measured with renography correlated with those measured with microspheres (left kidney: r = 0.67, P = 0.005; r = 0.71, P = 0.003, respectively; right kidney: r = 0.62, P = 0.01; r = 0.68, P = 0.004, respectively). We conclude that the proposed kinetic model of renal 123I-hippuran handling can be used to measure changes in intrarenal blood flow distribution and, because of its noninvasive character, may be of use in clinical studies.

Impact of cyclo-oxygenase blockade on juxtamedullary microvascular responses to angiotensin II in rat kidney

1. Experiments were designed to evaluate the hypothesis that cyclo-oxygenase products modulate the influence of angiotensin II (AII) on the renal juxtamedullary microvasculature of enalaprilat-treated rats. 2. The in vitro blood-perfused juxtamedullary nephron technique was utilized to provide access to afferent arterioles, efferent arterioles and descending vasa recta located in the outer stripe of the outer medulla. 3. Baseline afferent arteriolar diameter was 20.8 +/- 1.9 microns in kidneys subjected to cyclo-oxygenase blockade (1 mumol/L piroxicam), a value significantly lower than that observed in untreated kidneys (26.1 +/- 1.0 microns). Baseline diameters of efferent arterioles and outer medullary descending vasa recta did not differ between untreated and piroxicam-treated groups. 4. Topical application of 1 nmol/L AII reduced blood flow through outer medullary descending vasa recta by 22 +/- 6% in untreated kidneys and by 24 +/- 7% in piroxicam-treated kidneys. 5. In untreated kidneys, AII (0.01-100 nmol/L) produced concentration-dependent afferent and efferent arteriolar constrictor responses of similar magnitudes. Neither afferent nor efferent arteriolar AII responsiveness was significantly altered in piroxicam-treated kidneys, although afferent responses exceeded efferent responses at AII concentrations > or = 10 nmol/L. 6. We conclude that endogenous cyclo-oxygenase products exert a vasodilator influence on juxtamedullary afferent arterioles under baseline conditions. Although cyclo-oxygenase inhibition had little effect on juxtamedullary microvascular responses to AII, the response to high AII concentrations may be modulated by cyclo-oxygenase products in a manner which delicately alters the relative influence of the peptide on pre- vs postglomerular resistances.

Renal medullary microcirculation: architecture and exchange

The architecture of the renal medullary microcirculation is highly specialized. Consistent with their role in countercurrent exchange, the vessels (the vasa recta and the intervening capillaries) have high permeabilities to fluid and small hydrophilic solutes. The urea permeability of the continuous endothelium of the descending vasa recta (DVR) in the outer medulla is greatly enhanced by a urea transporter. Aquaporin channels have also been identified in these vessels. In spite of the absence of lymphatics from the inner medulla, fluid uptake from the interstitial fluid (ISF) through the fenestrated endothelium of the ascending vasa recta (AVR) appears to be driven by differences in hydrostatic and oncotic pressure. Because the AVR have high Lp's [10(-5) cm s-1 (cm H2O)-1] and are mechanically linked to surrounding structures, small increments of ISF pressures above the pressure within the AVR can drive significant volumes of fluid into AVR if ISF volume expands. The lower reflection coefficients to serum albumin of the AVR as compared with the DVR may be important in the clearance of interstitial plasma protein. Recent work on isolated DVR from the outer medulla has revealed that these vessels are capable of vasoconstriction and thus of regulating medullary blood flow.

Effect of norepinephrine and acetylcholine on outer medullary descending vasa recta

To examine their responsiveness to norepinephrine (NE) and acetylcholine (ACh), outer medullary descending vasa recta (OMDVR) have been dissected from vascular bundles of the rat and perfused in vitro. Abluminal application of NE produced graded vasoconstriction in a concentration range of 10(-9)-10(-6) M. When applied with NE, ACh at concentrations of 10(-8)-10(-5) M dilated NE-preconstricted OMDVR. In contrast, ACh applied in the absence of NE caused vasoconstriction. ACh-induced vasodilation was blocked by addition of the nitric oxide synthase inhibitor N omega-nitro-L-arginine (L-NNA, 2 x 10(-4) M). L-NNA in the absence of ACh enhanced NE-induced vasoconstriction. Supraphysiological (10(-3) M) L-arginine (L-Arg) reversed the effects of L-NNA, and abluminal application of L-NNA alone resulted in OMDVR vasoconstriction. At concentrations of 10(-6)-10(-3) M, abluminal application of L-Arg produced graded vasodilation of NE-constricted OMDVR. These results suggest that adrenergic and cholinergic innervation could influence OMDVR vasomotor tone to modulate total and regional blood flow to the renal medulla. The data also favor a role for the activity of constitutively expressed nitric oxide synthase to modulate OMDVR vasoactivity.

Diffusive transport of solute in the rat medullary microcirculation

Outer medullary descending vasa recta (OMDVR) permeability to sodium (PNa) is much lower than to urea (Purea). Based on these findings, we hypothesized that sodium and urea diffuse across the OMDFR wall by separate routes. To further test this, we simultaneously perfused OMDVR with 22Na and 36Cl, [14C]urea, [3H]raffinose, or tritiated water. The permeability of OMDVR to 22Na and [3H]raffinose was found to increase markedly and reversibly with perfusion rate. PNa was highly correlated with the permeability to Cl (PCl) and to [3H]raffinose (Praf) (R = 0.90 and 0.95, respectively) but not with Purea (R = 0.23). Praf was also correlated with inulin permeability (PIn) (R = 0.93). The intercepts for the regressions of PNa with PCl and Praf and for Praf with PIn were zero. In contrast, OMDVR with low PNa retained very high diffusional water permeability (PD) and Purea, a finding consistent with separate routes for permeation of those tracers. We previously established that thiourea is a competitive inhibitor of OMDVR urea transport. In the presence of 100 mM thiourea, OMDVR PNa and Purea were correlated (R = 0.71) but retained an intercept much > 0. We conclude that Na, Cl, raffinose, and inulin are likely to traverse the OMDVR wall through a common pathway, whereas specific mechanisms exist to regulate the permeation by urea and water.

Control of renal medullary blood flow by vasopressin V1 and V2 receptors

Experiments were performed in anesthetized renal-denervated rats to determine the contribution of renal medullary vasopressin V1 and V2 receptor stimulation in the regulation of renal medullary blood flow. Renal medullary interstitial infusion of the selective V1 agonist [Phe2,Ile3,Orn8]vasopressin (2 ng.kg-1.min-1) significantly decreased outer medullary blood flow by 15% and inner medullary blood flow by 35%, as measured with implanted optical fibers for laser-Doppler flowmetry. Medullary interstitial infusion of equimolar doses of arginine vasopressin (AVP) also decreased outer medullary blood flow by 15% but decreased inner medullary blood flow by only 17%, a decrease significantly less than that during the infusion of the V1 agonist. These results were confirmed in videomicroscopy experiments on the exposed papilla, which demonstrated that the V1 agonist and AVP decreased descending and ascending vasa recta capillary red blood cell velocity and calculated blood flow, with greater decreases during infusion of the V1 agonist. In further laser-Doppler flowmetry studies, stimulation of V2 receptors by medullary interstitial infusion of 1-desamino-8-D-arginine vasopressin (2 ng.kg-1.min-1) or AVP in rats pretreated with the vasopressin V1 receptor antagonist d(CH2)5[Tyr(Me)2,Ala-NH2]AVP increased renal medullary blood flow by 16 +/- 3 and 27 +/- 8%, respectively. The present experiments indicate that vasopressin V1 receptor stimulation serves to decrease renal medullary blood flow while V2 receptor stimulation appears to increase renal medullary blood flow; however, the net effect of AVP is to decrease renal medullary blood flow.

[Influence of hypotensive anesthesia on the organ blood flow--comparison of trinitroglycerine and nicardipine]

Adult mongrel dogs under anesthesia with 50% N2O + 0.5% halothane were further subjected to hypotensive anesthesia. For hypotensive anesthesia, we used two different drugs: trinitroglycerine (TNG-group) and nicardipine (NIC-group). In each of these groups, we measured respiratory and circulatory parameters and organ blood flow. The parameters of organ blood flow measured were renal cortical blood flow (RCBF), renal medullarly blood flow (RMBF), liver blood flow (LBF) and muscle blood flow (MBF). At the same time, distribution of organ blood flow was also determined. In TNG-group, significant decreases were observed in CI, LV dp/dt max, MPAP and PCWP due to decrease in venous return. In NIC-group, CI and LV dp/dt max increased significantly. No significant changes were seen in PaO2 in both groups. During hypotensive anesthesia organ blood flow decreased in all sites in TNG-group. However, as to blood distribution rate in TNG-group, RCBF and RMBF increased significantly, while a decreasing tendency was seen in MBF. On the other hand, in NIC-group RCBF decreased significantly, while MBF increased significantly. In NIC-group, distribution rate of RCBF, RMBF and LBF decreased significantly, but MBF showed a tendency to increase. From these results, it was indicated that hypotensive anesthesia using NIC may be associated with increased bleeding from the operative field due to increase in MBF.

Prostaglandin E2 abrogates endothelin-induced vasoconstriction in renal outer medullary descending vasa recta of the rat

Endothelins (ET) and prostaglandin E2 are synthesized in the inner medulla by collecting duct epithelium and interstitial cells, respectively. All ascending vasa recta (AVR) blood returns from the inner medulla to the cortex in outer medullary vascular bundles. We reasoned that hormones might influence medullary blood flow by diffusing across AVR fenestrations to modulate vasoconstriction of outer medullary descending vasa recta (OMDVR). To investigate this possibility, OMDVR dissected from vascular bundles were exposed to ET-1, 2, or 3. Each endothelin isoform induced stable vasoconstriction with potency, ET-1 > ET-2 > ET-3 (EC50, 1.8 x 10(-15), 5.9 x 10(-12), and 8.8 x 10(-10) M, respectively). The ETA receptor antagonist BQ-123 and BQ-610 (10(-6) M), as well as an ETA and ETB receptor antagonist combination, attenuated vasoconstriction due to ET-1 (10(-12) M). BQ-123 had no effect on the response to ET-3 (10(-8) M). The ETB receptor antagonist BQ-788 (10(-6) M) attenuated the response to ET-3 (10(-10) M), but not that to ET-1 (10(-12) M). Finally, PGE2 (10(-6) M) reversibly dilated OMDVR preconstricted with ET-1 (10(-12) M) or ET-3 (10(-8) M) but not ET-1 (10(-10) M). We conclude that ET-1,2, and 3 are potent constrictors of OMDVR and the response to ET-1 is mainly ETA receptor subtype mediated, while ET-3 acts via the ETB. PGE2 modulates ET induced constriction. These findings are consistent with interactive feedback and control of medullary perfusion by locally synthesized hormones.

The renal medulla and hypertension

We review evidence supporting the conclusion that renal dysfunction underlies the development of all forms of hypertension in humans and experimental animals. Indexes of global renal function are generally normal in the early stages of most genetic forms of hypertension, but renal function is clearly impaired in long-established hypertension. Studies in our laboratory over the past decade summarized below have established that the renal medulla plays an important role in sodium and water homeostasis and in the long-term control of arterial pressure. Development of implanted optical fibers for measurement of cortical and medullary blood flows with laser-Doppler flowmetry and techniques for delivery of vasoactive compounds into the medullary interstitial space enabled us to examine determinants of medullary flow (nitric oxide, atrial natriuretic peptides, kinins, eicosanoids, vasopressin, renal sympathetic nerves, etc). We have shown in spontaneously hypertensive rats that the initial changes of renal function begin as a reduction of medullary blood flow in the absence of changes of cortical flow. Long-term medullary interstitial infusion of captopril, which preferentially increased medullary blood flow, resulted in a lowering of arterial pressure. In normal Sprague-Dawley rats, selective reduction of medullary flow with medullary interstitial or intravenous infusion of small amounts of NG-nitro-L-arginine methyl ester resulted in hypertension. These and other studies we review show that although blood flow to the inner renal medulla comprises less than 1% of the total renal blood flow, changes in flow to this region can have a major effect on sodium and water homeostasis and on the long-term control of arterial blood pressure.

Comparison of central core and radially separated models of renal inner medulla

In this paper we describe the effect of partitioning exchange of ascending thin limb (ATL) and collecting duct (CD) between a central vascular space (CORE) and a radially separated capillary node (NODE) in a mathematical model of the concentrating mechanism of the renal inner medulla. A detailed description of the model has been provided [J. L. Stephenson, J. F. Jen, H. Wang, and R. P. Tewarson. Am. J. Physiol. 268 (Renal Fluid Electrolyte Physiol. 37): F680-F692, 1995]. We define a partition coefficient theta, which denotes the fractional exchange of CD and ATL with the NODE. Thus with theta = 0 we have a central core model, in which the ATL and CD exchange with the CORE only, and with theta = 1 we have a totally radially separated model, in which the ATL and CD exchange with the NODE only. Decreasing the partition coefficient from 1 to 0 effects a continuous transition from a totally radially separated model to a central core model. As this transition progresses with increasing exchange with the CORE, the osmolalities in all structures become nearly the same at the papilla, and the ability to transport salt uphill is lost. This is true even with no radial diffusion. However, radial diffusion and direct exchange with the CORE act synergistically in decreasing osmolality differences at the papilla and the capacity for convective uphill transport. These are lost in a more or less parallel way. There is, however, no significant concomitant change in concentrating ability. These results indicate that models with radial mixing of the interstitial vascular space are probably reasonably good approximations for the inner medulla.

Subatmospheric closing pressures in individual microvessels of rats and frogs

1. We have investigated the hypothesis that ascending vasa recta (AVR) in the rat renal medulla are able to remain open when the external pressure is greater than the internal. 2. Individual vasa recta were cannulated in anaesthetized rats with Evans Blue albumin solution and then occluded downstream prior to the first branchpoint. When the intraluminal pressure was lowered, the lumina collapsed at a mean pressure of approximately -4.0 cmH2O for both AVR and descending vasa recta. 3. The studies were extended to include microvessels from rat spinotrapezius muscle and mesentery and frog mesentery; mean closing pressures were -3.2, -4.2 and -5.3 cmH2O, respectively. 4. Subatmospheric closing pressures may allow small differences in hydrostatic pressure alone to drive fluid uptake into the AVR.

Pressure dependency of canine intrarenal blood flow within the range of autoregulation

The mechanism of pressure-induced natriuresis remains controversial. To assess whether intracortical or medullary renal blood flows (RBF) change with changes in renal perfusion pressure (RPP), global and regional RBFs were measured using the dynamic spatial reconstructor, a fast computed tomography scanner, in eight anesthetized dogs (group B) within the range of RBF autoregulation (RPP of 153.5 and 114.4 mmHg). Similar measurements were obtained in seven control dogs (group A) in which RPP was not manipulated. In group B, only inner medullary perfusion decreased (from 0.84 to 0.51 ml/min per cm3 of tissue, P = 0.03) with reduction of RPP, whereas global renal, intracortical, and outer medullary perfusions remained unaltered. In group A there was no change in global or regional renal perfusion. The change in inner medullary perfusion in group B (-34.7%) was significantly different (P = 0.021) from that in group A (+27.4%). Global, cortical, and total medullary RBFs (ml/min) and volumes did not change in either group. These results suggest that with changes in RPP, the only detectable change in intrarenal perfusion occurs in the inner medulla.

Prevention of renal cortical ischemia during aortic clamping with prostaglandin E1

OBJECTIVES

To investigate the effects of aortic clamping and prostaglandin E1 on systemic hemodynamics and renal cortical and medullary blood flow by means of continuous intraparenchymal laser Doppler fluorometry.

DESIGN

Experimental animal study in a porcine model. With the animal under general anesthesia after hemodynamic monitoring was instituted, surgical exposure was obtained through a small left retroperitoneal incision. The kidney was left undisturbed. Intraparenchymal laser Doppler probes (0.44 mm in diameter) were inserted in the renal cortex and medulla. In the first group of six animals, systemic hemodynamic variables, urine output and renal cortical and medullary flow were measured at baseline after 60 minutes of equilibration, and after 15 minutes of aortic clamping and unclamping. Data are given as mean +/- SE.

INTERVENTION

In another six animals, prostaglandin E1 (20-micrograms intravenous bolus given over 1 minute) was given before clamping, and the same variables were recorded.

RESULTS

In the first group, aortic clamping caused no change in cardiac output or filling pressures. Cortical blood flow decreased from 40.4 +/- 3.7 to 33.3 +/- 2.7 mL/100 g per minute (P < .0004) after clamping, and to 27 +/- 2.3 mL/100 g per minute (P < .0001) after unclamping, and was associated with a decrease in urine output from 3.2 +/- 0.5 to 2 +/- 0.2 mL/min (P < .0013). Medullary flow remained the same at 9.2 +/- 0.8, 10 +/- 0.3, and 9.8 +/- 0.6 mL/100 g per minute, respectively. These adverse effects were prevented when prostaglandin E1 was given before clamping. There was an initial drop in blood pressure (100 +/- 4 to 89 +/- 5 mm Hg, P < .0004), but cardiac output (43.3 +/- 5.8 L/min) and filling pressures (6 +/- 1 mm Hg) were unchanged. Cortical flow was preserved during the entire period of clamping and unclamping (43.3 +/- 5.8 mL/100 g per minute). Medullary flow remained unchanged (10 +/- 0.8 mL/100 g per minute). Urine output increased from 2 +/- 0.3 to 3.4 +/- 0.6 mL/min (P < .006).

CONCLUSIONS

In this animal model, infrarenal aortic clamping causes a significant decrease in renal cortical flow and urine output with no significant changes in filling pressures, cardiac output, or medullary blood flow. These adverse effects are prevented by pretreatment with prostaglandin E1, which prevents cortical ischemia and maintains brisk diuresis.

Role of nitric oxide on papillary blood flow and pressure natriuresis

This study examined whether nitric oxide synthesis blockade or potentiation (with N omega-nitro-L-arginine methyl ester [L-NAME] or N-acetylcysteine, respectively) can shift the relations between sodium excretion, papillary blood flow, and renal perfusion pressure. Papillary blood flow was measured by laser Doppler flowmetry. A low dose of L-NAME (3.7 nmol/kg per minute) reduced papillary blood flow only at high arterial pressure (140 mm Hg), but it had no effect on pressure natriuresis. Infusion of 37 nmol/kg per minute L-NAME reduced cortical blood flow by 9% at all perfusion pressures studied, lowered papillary blood flow by 8% and 19% at 120 and 140 mm Hg, respectively, and blunted the pressure-natriuresis response. The administration of 185 nmol/kg per minute L-NAME reduced cortical blood flow by 30% and decreased papillary blood flow by 25% in the range of 100 to 140 mm Hg of arterial pressure. Blockade of nitric oxide synthesis with L-NAME at all doses studied reduced papillary blood flow only at high renal perfusion pressures, but papillary blood flow remained essentially unchanged at low perfusion pressures, thus restoring papillary blood flow autoregulation. N-Acetyl-cysteine (1.8 mmol/kg) increased papillary blood flow by 9% and shifted the relations between papillary blood flow, sodium excretion, and renal perfusion pressure toward lower pressures. This effect of N-acetylcysteine on papillary blood flow was blocked by subsequent L-NAME administration.(ABSTRACT TRUNCATED AT 250 WORDS)

Role of renal medullary blood flow in the development of L-NAME hypertension in rats

The effect of chronic intravenous infusion of the nitric oxide inhibitor NG-nitro-L-arginine methyl ester (L-NAME; 8.6 mg.kg-1.day-1) on blood pressure, intrarenal blood flow distribution, and sodium and water balance was studied in conscious rats. On the 1st day of intravenous L-NAME infusion, renal medullary blood flow was reduced by 22%, renal cortical blood flow was unaltered, approximately 1 meq of sodium and 12 ml of water were retained, and blood pressure increased from 96 +/- 2 to 118 +/- 2 mmHg. Medullary blood flow was maintained at this decreased level, sodium continued to be retained, body weight continued to increase, and blood pressure remained elevated for the 5 days of L-NAME infusion. During the postcontrol period, blood flow in the renal medulla returned to levels not significantly different from control; the animals went into negative sodium balance and stopped gaining weight, and blood pressure returned to control. The present experiments indicate that decreased renal medullary blood flow and retention of sodium and water play an important role in the development of hypertension during chronic systemic L-NAME administration despite no measurable changes in renal cortical blood flow.

USPIO-enhanced MR imaging of glycerol-induced acute renal failure in the rabbit

Enhanced-MR imaging in combination with ultrasmall superparamagnetic iron oxide (USPIO) was used in the glycerol-induced model of acute renal failure (ARF) in the rabbit to detect renal perfusion abnormalities. A control group (n = 5) and an ARF group (n = 5) were studied after intramuscular injection of glycerol (10 ml/kg) with T2-weighted spin-echo sequence at 1.5 T and a 27 mumol/kg IV dose of iron. The signal intensity (SI) was quantified in the cortex, the outer medulla (OM), and the inner medulla (IM). In control rabbits, the maximum SI decrease after USPIO injection was in the OM (76% +/- 3.6), as this is the region of maximal vascular density, then in the IM (73.4% +/- 2.9). In the glycerol group, SI loss in the OM (61% +/- 12.6) and the IM (45.2% +/- 16.24) was significant less than in the control group (p < .05). Pathology results showed fibrinous thrombus in the efferent arterioles and congestive aspect of the vasa recta in the medulla. We argue that a reduced medullary concentration of USPIO in the renal failure group is indicative of medullary hypoperfusion.

Determinants of intrarenal oxygenation. II. Hemodynamic effects

To study hemodynamic effects on intrarenal oxygenation, O2 microelectrodes were inserted into rat kidneys. In a previous study [M. Brezis, Y. Agmon, and F. H. Epstein. Am. J. Physiol. 267 (Renal Fluid Electrolyte Physiol. 36): F1059-F1062, 1994], we showed that tubular metabolism is a major determinant of intrarenal oxygenation, in part responsible for medullary hypoxia observed under basal conditions. Acute hypotension (by controlled hemorrhage, aortic ligation, or nitroprusside infusion) paradoxically increased medullary PO2 (from 21 +/- 2 to 39 +/- 2 mmHg, P < 0.001) while decreasing cortical PO2 (from 46 +/- 2 to 32 +/- 3 mmHg, P < 0.001), abolishing corticomedullary gradients of oxygen. Laser-Doppler studies indicated that, while cortical blood flow was reduced during hypotension, medullary blood flow was unchanged or increased. The increase in medullary PO2 induced by hypotension was abolished by prior administration of furosemide, suggesting that during hypotension, reduced glomerular filtration rate (GFR), distal delivery, and reabsorption result in decreased oxygen utilization. Acute infusions of atriopeptin III (0.1-1 microgram.kg-1.min-1) decreased both cortical PO2 (from 61 +/- 2 to 55 +/- 2 mmHg, P < 0.001) and medullary PO2 (from 15 +/- 1 to 7 +/- 1 mmHg, P < 0.001), consistent with atriopeptin-induced increases in GFR and tubular reabsorptive work. These data suggest that medullary oxygen availability increases during renal hypoperfusion and may decrease during renal vasodilation.