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Liu B, Zhao J, Chen X, Fang K, Yang W, Zhang X, Shu C. Hemodynamic analysis of unilateral and bilateral renal artery stenosis based on fluid-structure interaction. Comput Methods Biomech Biomed Engin 2023:1-12. [PMID: 38009048 DOI: 10.1080/10255842.2023.2282949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/07/2023] [Indexed: 11/28/2023]
Abstract
Renal artery stenosis (RAS) hypertension is a common type of secondary hypertension. This paper aimed to explore how unilateral renal artery stenosis (Uni-RAS) and bilateral renal artery stenosis (Bi-RAS) caused renovascular hypertension with the fluid-structure interaction (FSI) method. Based on a real RAS model, 20 ideal models with different stenosis degrees were established by modifying the stenosis segment. The hemodynamic parameters at different degrees of stenosis, mass flow rate (MFR), pressure drop (PD), fractional flow reserve (FFR), oscillatory shear index (OSI), and relative residence time (RRT), were numerically calculated by the computational fluid dynamics (CFD) method. The numerical results showed that RAS caused the decrease of MFR, and the increase of PD and the proportion of high OSI and high RRT. In the case of RAS, it could not be regarded as a reference indicator for causing renovascular hypertension that the value of FFR was greater than 0.9. In addition, the results of the statistical analysis indicated that Uni-RAS and Bi-RAS were statistically different for MFR, PD and the proportion of high RRT.
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Affiliation(s)
- Bingxin Liu
- School of Mathematics and Physics, University of Science and Technology Beijing, Beijing, China
| | - Jiawei Zhao
- Department of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuehui Chen
- School of Mathematics and Physics, University of Science and Technology Beijing, Beijing, China
| | - Kun Fang
- Department of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weidong Yang
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, China
| | - Xuelan Zhang
- School of Mathematics and Physics, University of Science and Technology Beijing, Beijing, China
| | - Chang Shu
- Department of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Cooper EL, Xie Y, Nguyen H, Brewster PS, Sholl H, Sharrett M, Ren K, Chen T, Tuttle KR, Haller ST, Jamerson K, Murphy TP, D'Agostino RB, Massaro JM, Henrich W, Cooper CJ, Cutlip DE, Dworkin LD, Shapiro JI. Early Rapid Decline in Kidney Function in Medically Managed Patients With Atherosclerotic Renal Artery Stenosis. J Am Heart Assoc 2019; 8:e012366. [PMID: 31433717 PMCID: PMC6585374 DOI: 10.1161/jaha.119.012366] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/26/2019] [Indexed: 11/29/2022]
Abstract
Background Early rapid declines of kidney function may occur in patients with atherosclerotic renal artery stenosis with institution of medical therapy. The causes and consequences are not well understood. Methods and Results Patients enrolled in the medical therapy-only arm of the CORAL (Cardiovascular Outcomes With Renal Artery Lesions) study were assessed for a rapid decline (RD) in estimated glomerular filtration rate (eGFR), defined as a ≥30% decrease from baseline to either 3 months, 6 months, or both. In the medical therapy-only cohort, eGFR was available in 359 subjects at all time points, the subjects were followed for a median of 4.72 years, and 66 of 359 (18%) subjects experienced an early RD. Baseline log cystatin C (odds ratio, 1.78 [1.11-2.85]; P=0.02), age (odds ratio, 1.04 [1.00-1.07]; P<0.05), and Chronic Kidney Disease Epidemiology Collaboration creatinine eGFR (odds ratio, 1.86 [1.15-3.0]; P=0.01) were associated with an early RD. Despite continued medical therapy only, the RD group had an improvement in eGFR at 1 year (6.9%; P=0.04). The RD and nondecline groups were not significantly different for clinical events and all-cause mortality (P=0.78 and P=0.76, respectively). Similarly, renal replacement therapy occurred in 1 of 66 (1.5%) of the RD patients and in 6 of 294 (2%) of the nondecline patients. The regression to the mean of improvement in eGFR at 1 year in the RD group was estimated at 5.8±7.1%. Conclusions Early rapid declines in kidney function may occur in patients with renal artery stenosis when medical therapy is initiated, and their clinical outcomes are comparable to those without such a decline, when medical therapy only is continued.
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Affiliation(s)
- Emily L. Cooper
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Yanmei Xie
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Hanh Nguyen
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Pamela S. Brewster
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Haden Sholl
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Megan Sharrett
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Kaili Ren
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Tian Chen
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Katherine R. Tuttle
- Division of NephrologyUniversity of Washington School of MedicineProvidence Sacred Heart Medical CenterSpokaneWA
| | - Steven T. Haller
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | | | - Timothy P. Murphy
- Department of Diagnostic ImagingRhode Island Hospital and Alpert Medical School of Brown UniversityProvidenceRI
| | | | - Joseph M. Massaro
- Department of BiostatisticsSchool of Public HealthBoston UniversityBostonMA
| | | | - Christopher J. Cooper
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
| | - Donald E. Cutlip
- Department of MedicineHarvard UniversityBeth Israel Deaconess Medical CenterBostonMA
| | - Lance D. Dworkin
- Department of MedicineUniversity of Toledo College of Medicine and Life SciencesToledoOH
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LIU MING, SUN ANQIANG, DENG XIAOYAN. HEMODYNAMIC EFFECT OF OBSTRUCTION TO RENAL ARTERIES CAUSED BY STENT GRAFTS IN PATIENTS WITH ABDOMINAL AORTIC ANEURYSMS. J MECH MED BIOL 2018. [DOI: 10.1142/s0219519418400146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To investigate the hemodynamic effects of partial obstruction to the renal orifice caused by inappropriate stent-graft location. Pre-operative and deployment models of a stent graft with various degrees of obstruction to the renal orifice are constructed based on medical images of abdominal aortic aneurysm. Hemodynamics, including flow pattern, time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), as well as relative residence time (RRT) are analyzed using numerical simulations. Flow rate distributions are assessed and verified by in vitro experiments. Results show that partial blockage to the renal branch orifice leads to flow recirculation and vortices with low wall shear stress around the renal ostia, whereas OSI and RRT on the renal arteries increase with the degree of obstruction. While the in vitro experiment indicates a decreasing flow rate to the bilateral renal arteries as renal artery ostia are obstructed. In conclusion, obstruction to the renal arteries induced by an inappropriate stent graft location causes stenosis in the renal artery in the long term. This study reveals a possible pathological mechanism of renal complications due to the implantation of a stent graft.
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Affiliation(s)
- MING LIU
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science & Medical Engineering, Beihang University, Beijing 100083, P. R. China
| | - ANQIANG SUN
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science & Medical Engineering, Beihang University, Beijing 100083, P. R. China
- Beijing Advanced Innovation, Centre for Biomedical Engineering, Beihang University, Beijing 100083, P. R. China
| | - XIAOYAN DENG
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science & Medical Engineering, Beihang University, Beijing 100083, P. R. China
- Beijing Advanced Innovation, Centre for Biomedical Engineering, Beihang University, Beijing 100083, P. R. China
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Franchi F, Zhu XY, Witt TA, Lerman LO, Rodriguez-Porcel M. Intravascular Delivery of Biologics to the Rat Kidney. J Vis Exp 2016. [PMID: 27685329 DOI: 10.3791/54418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The renal microvascular compartment plays an important role in the progression of kidney disease and hypertension, leading to the development of End Stage Renal Disease with high risk of death for cardiovascular events. Moreover, recent clinical studies have shown that renovascular structure and function may have a great impact on functional renal recovery after surgery. Here, we describe a protocol for the delivery of drugs into the renal artery of rats. This procedure offers significant advantages over the frequently used systemic administration as it may allow a more localized therapeutic effect. In addition, the use of rodents in pharmacodynamic analysis of preclinical studies may be cost effective, paving the way for the design of translational experiments in larger animal models. Using this technique, infusion of rat recombinant Vascular Endothelial Growth Factor (VEGF) protein in rats has induced activation of VEGF signaling as shown by increased expression of FLK1, pAKT/AKT, pERK/ERK. In summary, we established a protocol for the intrarenal delivery of drugs in rats, which is simple and highly reproducible.
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Affiliation(s)
- Federico Franchi
- Divisions of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic
| | - Xiang Yang Zhu
- Divisions of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic
| | - Tyra A Witt
- Divisions of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic
| | - Lilach O Lerman
- Divisions of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic
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Brouwers JJ, van Wissen RC, Veger HT, Rotmans JI, Mertens B, Visser MJ. The use of intrarenal Doppler ultrasonography as predictor for positive outcome after renal artery revascularization. Vascular 2016; 25:63-73. [PMID: 27118604 DOI: 10.1177/1708538116644871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Whether patients with renal artery stenosis should undergo therapeutic revascularization is controversial. In this retrospective study, we evaluated prognostic intrarenal Doppler ultrasound parameters that might have a predictive value for a beneficial response after renal revascularization. From January 2003 until December 2012, all renovascular interventions for renal artery stenosis were analyzed. The resistive index and the maximal systolic acceleration were determined by Doppler ultrasonography prior to intervention. Thirty-two patients who underwent a renal revascularization procedure were included: 13 combined positive responders and 19 combined non-responders. The combined positive responders had a significant lower resistive index than the combined non-responders (0.5 vs. 0.6, P = 0.001) and a significant lower maximal systolic acceleration (1.0 vs. 3.8, P = 0.001) before revascularization. A prediction model (RI ≤ 0.5 and ACCmax ≤ 1.3 m/s2) was formulated to identify a subgroup that benefits from renal revascularization. This model has an expected sensitivity of 69% and specificity of 89% for improvement in renal function and/or blood pressure after revascularization. The non-invasive intrarenal Doppler ultrasound parameters resistive index and maximal systolic acceleration can be used as tools to predict improvement in renal function and/or blood pressure after revascularization of renal artery stenosis. The clinical value of this prediction model should be evaluated in a prospective trial.
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Affiliation(s)
- Jeroen Jwm Brouwers
- 1 Department of Vascular Surgery, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Rob C van Wissen
- 1 Department of Vascular Surgery, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Hugo Tc Veger
- 2 Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Joris I Rotmans
- 3 Department of Nephrology, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Bart Mertens
- 4 Department of Medical Statistics and Bioinformatics, Leiden University Medical Center (LUMC), Leiden, the Netherlands
| | - Michel Jt Visser
- 1 Department of Vascular Surgery, Leiden University Medical Center (LUMC), Leiden, the Netherlands
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Effect of Huanshuai Recipe Oral Liquid ([characters: see text]) on renal dysfunction progression in patients with atherosclerotic renal artery stenosis. Chin J Integr Med 2015; 21:811-6. [PMID: 25847775 DOI: 10.1007/s11655-015-2046-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the effect of Huanshuai Recipe Oral Liquid ([characters: see text], HSR) on retarding the progression of renal dysfunction in patients with atherosclerotic renal artery stenosis (ARAS). METHODS A total of 52 ARAS patients with the Chinese medicine (CM) syndrome of qi deficiency and blood stasis, phlegm and dampness retention were recruited and randomly assigned into the treatment group (36 cases) and the control group (16 cases). Both groups received a basic treatment (high-quality low-protein diet, blood pressure control, lipid-lowering, correcting the acidosis, etc.). In addition, the treatment group received 20 mL HSR and the control group received placebo, 3 times a day for 6 months. Renal function (serum creatinine, blood urea nitrogen and uric acid) and blood lipids (cholesterol, triglycerides and low density lipoprotein) were examined monthly. The estimated glomerular filtration rate (eGFR) and CM syndrome score were compared between groups. RESULTS After treatment, compared with the control group, the serum creatinine level, uric acid level and CM syndrome score of the treatment group were significantly decreased (P<0.05 or P<0.01), and the eGFR in the treatment group were significantly increased (P<0.05). CONCLUSION HSR can effectively improve the renal function and clinical symptoms of ARAS patients.
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Jennings CG, Houston JG, Severn A, Bell S, Mackenzie IS, MacDonald TM. Renal artery stenosis-when to screen, what to stent? Curr Atheroscler Rep 2014; 16:416. [PMID: 24743868 PMCID: PMC4010717 DOI: 10.1007/s11883-014-0416-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Renal artery stensosis (RAS) continues to be a problem for clinicians, with no clear consensus on how to investigate and assess the clinical significance of stenotic lesions and manage the findings. RAS caused by fibromuscular dysplasia is probably commoner than previously appreciated, should be actively looked for in younger hypertensive patients and can be managed successfully with angioplasty. Atheromatous RAS is associated with increased incidence of cardiovascular events and increased cardiovascular mortality, and is likely to be seen with increasing frequency. Evidence from large clinical trials has led clinicians away from recommending interventional revascularisation towards aggressive medical management. There is now interest in looking more closely at patient selection for intervention, with focus on intervening only in patients with the highest-risk presentations such as flash pulmonary oedema, rapidly declining renal function and severe resistant hypertension. The potential benefits in terms of improving hard cardiovascular outcomes may outweigh the risks of intervention in this group, and further research is needed.
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Affiliation(s)
- Claudine G. Jennings
- Medicines Monitoring Unit and Hypertension Research Centre, Ninewells Hospital and University of Dundee, Dundee, DD1 9SY UK
| | - John G. Houston
- Department of Radiology, Ninewells Hospital, Dundee, DD1 9SY UK
| | - Alison Severn
- Department of Renal Medicine, Ninewells Hospital, Dundee, DD1 9SY UK
| | - Samira Bell
- Department of Renal Medicine, Ninewells Hospital, Dundee, DD1 9SY UK
| | - Isla S. Mackenzie
- Medicines Monitoring Unit and Hypertension Research Centre, Ninewells Hospital and University of Dundee, Dundee, DD1 9SY UK
| | - Thomas M. MacDonald
- Medicines Monitoring Unit and Hypertension Research Centre, Ninewells Hospital and University of Dundee, Dundee, DD1 9SY UK
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Post-procedural renal microvascular perfusion measured using the Quantitative Blush Evaluator (QuBE) predicts improvement in renal function in patients undergoing percutaneous renal artery stenting. Int J Cardiol 2014; 172:e127-9. [PMID: 24462144 DOI: 10.1016/j.ijcard.2013.12.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 12/22/2013] [Indexed: 11/22/2022]
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Liang P, Hurks R, Bensley RP, Hamdan A, Wyers M, Chaikof E, Schermerhorn ML. The rise and fall of renal artery angioplasty and stenting in the United States, 1988-2009. J Vasc Surg 2013; 58:1331-8.e1. [PMID: 23810297 PMCID: PMC3791161 DOI: 10.1016/j.jvs.2013.04.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 04/09/2013] [Accepted: 04/11/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Optimal management of renal artery stenosis (RAS) remains unclear. Recent randomized controlled trials have shown no clear benefit with percutaneous transluminal angioplasty with or without stenting (PTRA/S) over medical management. We hypothesize that interventions for RAS are decreasing nationally. METHODS The Nationwide Inpatient Sample, 1988-2009, was used to identify patients with a diagnosis of renal artery atherosclerosis undergoing open surgical repair (bypass or endarterectomy) or PTRA/S. The rate of interventions, in-hospital death, and perioperative outcomes were analyzed over time. Additionally, we used individual state inpatient and ambulatory databases to better understand the influence of outpatient procedures on current volume and trends. RESULTS We identified 308,549 PTRA/S and 33,147 open surgical repairs. PTRA/S increased from 1.9/100K adults in 1988 to 13.7 in 2006 followed by a decrease to 6.7 in 2009. Open surgical repair steadily decreased from 1.3/100K adults in 1988 to 0.3 in 2009. In 2009, PTRA/S procedures (6.4/100K adults) greatly outnumbered procedures done by open repair alone (0.1/100K), combined open renal and aortic repair (0.2/100K), and combined PTRA/S and endovascular aneurysm repair (0.3/100K). From 2005 to 2009 33,953 patients underwent PTRA/S in the states of New Jersey Maryland, Florida, and California combined. The total number of PTRA/S performed in the outpatient setting remained stable from 2005 (3.8/100K) to 2009 (3.7/100K), whereas the total number of inpatient procedures mirrored the national trend, declining from 2006 (7.9/100K) to 2009 (4.2/100K). PTRA/S had lower in-hospital mortality (0.9% vs 4.1%; P < .001) compared with open repair. PTRA/S patients were more likely to be discharged home (86.2% vs 76.3%; P < .001) and had a shorter length of stay (4.4 vs 12.3 days; P < .001). Mortality was higher after combined open renal and open aortic surgery compared to open repair alone (6.5% vs 4.1%; P < .001). Mortality was similar for combined PTRA/S and endovascular aneurysm repair compared with PTRA/S alone (1.2% vs 0.9%; P = .04). CONCLUSIONS The performance of PTRA/S procedures for the management of RAS has decreased significantly after 2006. An increasing proportion of these procedures are performed in the outpatient setting. PTRA/S remains the dominant revascularization procedure for RAS with lower in-hospital mortality and morbidity than surgery.
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Affiliation(s)
- Patric Liang
- Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass
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Nattel S. A Focus on Hypertension: A Modest Condition of Enormous Significance. Can J Cardiol 2011; 27:394-6. [DOI: 10.1016/j.cjca.2011.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 05/31/2011] [Indexed: 11/28/2022] Open
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