Renal blood flow, circulation times and vascular volume in normal man measured by the intraarterial injection--external counting technique

Quantitative Blood Oxygenation Level Dependent Magnetic Resonance Imaging for Estimating Intra-renal Oxygen Availability Demonstrates Kidneys Are Hypoxemic in Human CKD

Introduction

Kidney blood oxygenation level dependent (BOLD) magnetic resonance imaging (MRI) has shown great promise in evaluating relative oxygen availability. This method is quite efficacious in evaluating acute responses to physiological and pharmacologic maneuvers. Its outcome parameter, R2∗ is defined as the apparent spin-spin relaxation rate measured in the presence of magnetic susceptibility differences and it is measured using gradient echo MRI. Although associations between R2∗ and renal function decline have been described, it remains uncertain to what extent R2∗ is a true reflection of tissue oxygenation. This is primarily because of not taking into account the confounding factors, especially fractional blood volume (fBV) in tissue.

Methods

This case-control study included 7 healthy controls and 6 patients with diabetes and chronic kidney disease (CKD). Using data before and after administration of ferumoxytol, a blood pool MRI contrast media, the fBVs in kidney cortex and medulla were measured.

Results

This pilot study independently measured fBV in kidney cortex (0.23 ± 0.03 vs. 0.17 ± 0.03) and medulla (0.36 ± 0.08 vs. 0.25 ± 0.03) in a small number of healthy controls (n = 7) versus CKD (n = 6). These were then combined with BOLD MRI measurements to estimate oxygen saturation of hemoglobin (StO2) (0.87 ± 0.03 vs. 0.72 ± 0.10 in cortex; 0.82 ± 0.05 vs. 0.72 ± 0.06 in medulla) and partial pressure of oxygen in blood (bloodPO2) (55.4 ± 6.5 vs. 38.4 ± 7.6 mm Hg in cortex; 48.4 ± 6.2 vs. 38.1 ± 4.5 mm Hg in medulla) in control versus CKD. The results for the first time demonstrate that cortex is normoxemic in controls and moderately hypoxemic in CKD. In the medulla, it is mildly hypoxemic in controls and moderately hypoxemic in CKD. Whereas fBV, StO2, and bloodPO2 were strongly associated with estimated glomerular filtration rate (eGFR), R2∗ was not.

Conclusion

Our results support the feasibility of quantitatively assessing oxygen availability using noninvasive quantitative BOLD MRI that could be translated to the clinic.

Cardiopulmonary parameters and organ blood flows for workers expressed in terms of VO2 for use in physiologically based toxicokinetic modeling

Minute ventilation rates (VE), alveolar ventilation rates (VA), cardiac outputs (Q), liver blood flow (LBF) and kidneys blood flows (KBF) for physiologically based toxicokinetic modeling and occupational health risk assessment in active workers have apparently not been determined. Minute energy expenditure rates (E) and oxygen consumption rates (VO₂) in workers during exertions and their aggregate daytime activities are obtained by using open-circuit wearable devices for indirect calorimetry measurements and the doubly labeled water method respectively. Hundreds of E (in kcal/min) and VO₂ (in L of O₂/min) were previously reported for workers. The oxygen uptake factors of 0.2059 ± 0.0019 and 0.2057 ± 0.0018 L of O₂/kcal during postprandial and fasting phases respectively enabled conversion of E into VO₂. Equations determined in this study based upon more than 25 000 published measurements enable the calculation of 15 parameters in the same worker only by using the VO₂ reflecting workload. These parameters, notably VE, VA, VE/VO₂ VA/Q, Q, LBF and KBF were found to be interrelated. Altering one of these changes the order of magnitude of the others. Q, LBF and KBF decrease when supine adults at rest switch to an upright position. This effect of gravity diminished when VO₂ increased. The fall in LBF and KBF during exertion might enhance muscle blood flow as reported previously. Taken together these equations and data may improve the accuracy of physiologically based toxicokinetic modeling as well as occupational health assessment studies in active workers exposed to xenobiotics.List of main abbreviations: AVOD: arterioveinous oxygen content difference.BMI: body mass index (in kg/m²).BSA: body surface area (in m²).BTPS: body temperature and saturated with water vapor.Bw: body weight (in kg).E: minute energy expenditure rate (in kcal/min).F_GE: organ blood flow factor for the gravitational effect on blood circulation.H: oxygen uptake factor, volume of oxygen (at STPD) consumed to produce 1 kcal of energy expended.KBF: kidneys blood flow (in ml/min).LBF: liver blood flow (in ml/min).P_BF: liver or kidneys blood flows expressed in terms of percentages (in %) of Q_{sup C} values: namely P_BF = (LBF or KBF/Q_{sup C}) x 100.Q: cardiac output (in L/min or ml/min).Q_{sup C:} cardiac output for the cohort of males or females in supination (in ml/min).STPD: standard temperature and pressure, dry air.sup: values measured when adults are in the supine position.up: values measured when adults are in the upright position.VDphys: physiological dead space at BTPS (in L).VT: tidal volume at BTPS (in L).VA: alveolar ventilation rate at BTPS (in L/min).VA/Q: ventilation-perfusion ratio (unitless).VE: minute ventilation rate at BTPS (in L/min).VO₂: oxygen consumption rate (i.e. the oxygen uptake) at STPD (in L/min).VQ: ventilatory equivalent for VO₂ (VE at BTPS /VO₂ at STPD).

Angiotensin I-to-II conversion in the human renal vascular bed

OBJECTIVE

During previous studies in humans and pigs, using infusions of 125I-angiotensin into the right antecubital vein or the left cardiac ventricle, we were unable to demonstrate conversion of arterial angiotensin I in the renal vascular bed. The arterial 125I-angiotensin I levels in these studies may have been too low to result in detectable renal venous 125I-angiotensin II levels, especially in view of the extensive degradation of angiotensins in the kidney. To overcome this problem, we now infused 125I-angiotensin I directly into the renal artery.

DESIGN AND METHODS

Five subjects (three women, two men) with essential hypertension (n = 4) or unilateral renal artery stenosis (n = 1), not treated with an ACE inhibitor, were given a 10-min infusion of 125I-angiotensin I (3.6+/-0.4 x 10(6) cpm/min, mean +/- SEM) into the left (n = 4) or right (n = 1) renal artery. Blood samples for the measurement of endogenous and radiolabelled angiotensin I and II were taken under steady-state conditions from the aorta and the renal vein of the 125I-angiotensin I-perfused kidney.

RESULTS

At steady-state, the levels of 125I-angiotensin I in renal venous blood were 5-6 fold lower, and those of 125I-angiotensin II were 4-5 fold higher than in renal arterial blood. On the basis of these levels, angiotensin I extraction in the renal vascular bed was calculated to be 80+/-3%, of which 9+/-1% was due to angiotensin I-to-II conversion. The renal venous levels of endogenous angiotensin I were 50% higher than its arterial levels, whereas the levels of endogenous angiotensin II were 50% lower in renal venous blood than in arterial blood. Taking into consideration the regional metabolism of arterially delivered angiotensins, and the generation of angiotensin I in circulating blood by plasma renin activity, it could be calculated that renal venous angiotensin I is largely derived from renal tissue sites, and that renal venous angiotensin II has no other sources than arterially delivered angiotensin I and II and angiotensin I generated by plasma renin activity in the renal vascular bed.

CONCLUSIONS

Less than 10% of arterially delivered angiotensin I is converted to angiotensin II in the renal vascular bed. Conversion of angiotensin I generated at renal tissue sites does not contribute to the level of angiotensin II in the renal vein, although it is the main source of angiotensin II in renal tissue. Thus, the intrarenal formation of angiotensin II is highly compartmentalised.

Human vascular renin-angiotensin system and its functional changes in relation to different sodium intakes

A growing body of evidence supports the existence of a tissue-based renin-angiotensin system (RAS) in the vasculature, but the functional capacity of vascular RAS was not investigated in humans. In 28 normotensive healthy control subjects, the metabolism of angiotensins through vascular tissue was investigated in normal, low, and high sodium diets by the measurement of arterial-venous gradient of endogenous angiotensin (Ang) I and Ang II in two different vascular beds (forearm and leg), combined with the study of 125I-Ang I and 125I-Ang II kinetics. In normal sodium diet subjects, forearm vascular tissue extracted 36+/-6% of 125I-Ang I and 30+/-5% of 125I-Ang II and added 14.9+/-5.1 fmol x 100 mL(-1) x min(-1) of de novo formed Ang I and 6.2+/-2.8 fmol x 100 mL(-1) x min(-1) of Ang II to antecubital venous blood. Fractional conversion of 125I-Ang I through forearm vascular tissue was about 12%. Low sodium diet increased (P<.01) plasma renin activity, whereas de novo Ang I and Ang II formation by forearm vascular tissue became undetectable. Angiotensin degradation (33+/-7% for Ang I and 30+/-7% for Ang II) was unchanged, and vascular fractional conversion of 125I-Ang I decreased from 12% to 6% (P<.01). In high sodium diet subjects, plasma renin activity decreased, and de novo Ang I and Ang II formation by forearm vascular tissue increased to 22 and 14 fmol x 100 mL(-1) x min(-1), respectively (P<.01). Angiotensin degradation did not significantly change, whereas fractional conversion of 125I-Ang I increased from 12% to 20% (P<.01). Leg vascular tissue functional activities of RAS paralleled those of forearm vascular tissue both at baseline and during different sodium intake. These results provide consistent evidence for the existence of a functional tissue-based RAS in vascular tissue of humans. The opposite changes of plasma renin activity and vascular angiotensin formation indicate that vascular RAS is independent from but related to circulating RAS.

The measurement of blood flow in humans using radioactive tracers

Since the first description of the movement of blood around the body by William Harvey, the accurate measurement of blood velocity has provided a major challenge for medical science. This review looks at the contribution made by techniques using radioactive tracers. Initially consideration is given to the fundamental problem of how to measure the amount of radiotracer in an organ with sufficient accuracy, using both single-photon and positron-emitting tracers. The various models used to link tracer behaviour with blood flow are then discussed and the article closes with a detailed review of the clinical applications of blood flow measurements.

Quantification and parametric imaging of renal cortical blood flow in vivo based on Patlak graphical analysis

Patlak graphical analysis was applied to quantify renal cortical blood flow with N-13 ammonia and dynamic positron emission tomography. Measurements were made in a swine model of kidney transplantation with a wide range of normal and abnormal renal blood flows (N = 57 studies) and in 20 healthy human volunteers (N = 45 studies). Estimates of renal cortical blood flow by the Patlak method were compared to those from a two-compartment model for N-13 ammonia. In addition, estimates of renal cortical blood flow by the N-13 ammonia PET approach were compared in 10 normal human volunteers to estimates by the metabolically inert, freely diffusible O-15 water and a one-compartment model. Patlak graphical analysis estimates of renal cortical blood flow correlated linearly with the standard two-compartment model in pigs (y = -0.05 + 1.01x, r = 0.99) and in humans (y = 0.57 + 0.88x, r = 0.93). Estimates of renal cortical blood flow by O-15 water in human volunteers were also linearly correlated with those by N-13 ammonia and the Patlak graphical analysis (y = 0.71 + 0.84x, r = 0.86). Renal cortical blood flow estimates were highly reproducible both with N-13 ammonia and O-15 water measurements in humans. It is concluded that the Patlak graphical analysis with N-13 ammonia dynamic positron emission tomograpic imaging renders accurate and reproducible estimates of renal cortical blood flow. Moreover, the graphical analysis approach is 1,000 times faster than the standard model fitting approach and suitable for generating parametric images of renal blood flow in the clinical setting.

Intrarenal de novo production of angiotensin I in subjects with renal artery stenosis

To estimate the renal extraction and de novo production of angiotensin I and to assess the contribution of blood-borne renin to renal angiotensin I production, the aortic and renal venous plasma levels of renin and intact [125I]angiotensin I and endogenous angiotensin I during continuous systemic intravenous infusion of monoiodinated [125I]angiotensin I were measured in subjects with unilateral renal artery stenosis (n = 8) who were treated with captopril (50 mg b.i.d.). Results demonstrated that 80% of angiotensin I delivered by the renal artery was extracted both by the affected and the unaffected kidney and that on both sides a major part of angiotensin I in the renal vein was derived from intrarenal de novo production. Production of plasma angiotensin I was in excess over extraction (p less than 0.01) on the affected side, whereas extraction was in excess over production (p less than 0.01) on the contralateral side. The plasma level of de novo intrarenally produced angiotensin I in the renal vein was seven times higher on the affected side than the contralateral side. This difference was by far too big to be explained by a difference in the transit time of blood between the two kidneys, by an augmented production of angiotensin I in the circulating blood passing through the affected kidney due to the higher level of venous plasma renin activity in that kidney, or by the combination of both.(ABSTRACT TRUNCATED AT 250 WORDS)

Metabolism and production of angiotensin I in different vascular beds in subjects with hypertension

To study the metabolism and production of angiotensin I, highly purified monoiodinated [125I] angiotensin I was given by constant systemic intravenous infusion, either alone (n = 7) or combined with unlabeled angiotensin I (n = 5), to subjects with essential hypertension who were treated with the angiotensin converting enzyme inhibitor captopril (50 mg b.i.d.). Blood samples were taken from the aorta and the renal, antecubital, femoral, and hepatic veins. [125I]Angiotensin I and angiotensin I were extracted from plasma, separated by high-performance liquid chromatography, and quantitated by gamma counting and radioimmunoassay. Plasma renin activity was measured at pH 7.4. The plasma decay curves after discontinuation of the infusions of [125I]angiotensin I and unlabeled angiotensin I were similar for the two peptides. The regional extraction ratio of [125I]angiotensin I was 47 +/- 4% (mean +/- SEM) across the forearm, 59 +/- 3% across the leg, 81 +/- 1% across the kidneys, and 96 +/- 1% across the hepatomesenteric vascular bed. These results were not different from those obtained for infused unlabeled angiotensin I. Despite the rapid removal of arterially delivered angiotensin I, no difference was found between the venous and arterial levels of endogenous angiotensin I across the various vascular beds, with the exception of the liver where angiotensin I in the vein was 50% lower than in the aorta. Thus, 50-90% of endogenous angiotensin I in the veins appeared to be derived from regional de novo production. The blood transit time is 0.1-0.2 minute in the limbs and in the kidneys and 0.3-0.5 minute in the hepatomesenteric vascular bed. This is too short for plasma renin activity to account for the measured de novo angiotensin I production. It was calculated that less than 20-30% in the limbs and in the kidneys and approximately 60% in the hepatomesenteric region of de novo-produced angiotensin I could be accounted for by circulating renin. These results indicate that a high percentage of plasma angiotensin I may be produced locally (i.e., not in circulating plasma).

Reference values for resting blood flow to organs of man

The lack of a reliable quantitative description of blood flow in man has hampered the development of accurate biokinetic models of essential elements, drugs, imaging agents, and carcinogens. In this paper we review and analyse data on blood flow and identify representative percentages of cardiac output and absolute blood flow rates to organs and tissues of man for use as reference values for biokinetic models. To keep the review and analysis to a manageable size we have limited attention to the resting state and have suggested reference values for absolute and relative flow rates only for adult males and females.

Estimation of regional metabolism and production of angiotensins in hypertensive subjects

1. We attempted to collect information on the metabolism and production of angiotensins (ANG) in different vascular beds in humans by constant i.v. infusion of mono-iodinated [125I]-ANG I into subjects with essential hypertension, at the time of renal vein catheterization as part of the diagnostic work-up for renovascular hypertension. 2. Blood samples were taken from the aorta and the renal, antecubital, femoral and hepatic veins. ANG I, ANG II, [125I]-ANG I and [125I]-ANG II were extracted from plasma, separated by h.p.l.c. and quantitated by radio-immunoassay or gamma counting. 3. Our studies so far are restricted to subjects on captopril 50 mg twice daily. Under ACE inhibition (4-6 h after dosing of captopril) no differences in elimination half-life and regional extraction were found between infused [125I]-ANG and unlabelled ANG I. Extraction of arterially delivered [125I]-ANG I was 80% in the kidney, 45% in the forearm, 58% in the leg and 95% in the hepato-mesenteric vascular bed. 4. Measurements of arterial and venous [125I]-ANG II levels indicated that [125I]-ANG I-II conversion had occurred in the cardio-pulmonary vascular bed. 5. ANG I production in the hepato-mesenteric region could be largely accounted for by the renin activity of circulating plasma, but in kidney and limbs only 20-30% of regionally produced ANG I could be accounted for by plasma renin activity. 6. Thus, a major fraction of regionally produced ANG I appears to be formed locally, i.e. not in circulating plasma.(ABSTRACT TRUNCATED AT 250 WORDS)

Existence of atrial natriuretic polypeptide in kidney

Using a specific radioimmunoassay (RIA) for alpha-atrial natriuretic polypeptide (alpha-ANP), we have demonstrated the presence of alpha-rat ANP-like immunoreactivity (alpha-rANP-LI) in the rat kidney which is considered to be a target organ for atrial natriuretic polypeptides released from the heart. Most of alpha-rANP-LI was localized in the cortex. High performance gel permeation chromatography coupled with the RIA revealed that renal alpha-rANP-LI was eluted at the position of a low molecular weight form corresponding to alpha-rANP without detectable amounts of high molecular weight forms. This is in contrast to the observation that gamma-rANP, a high molecular weight form of 13k daltons, is the dominant form of alpha-rANP-LI in the rat atrium. In water-deprived rats, the concentration and content of alpha-rANP-LI in the kidney showed a significant decrease compared with control rats. In addition, the alpha-rANP-LI concentration and content in this organ revealed a substantial decrease after perfusion with physiological saline. These results indicate the existence of atrial natriuretic polypeptide (ANP) in the kidney and suggest that part of renal ANP may originate from the heart.

Organ scaling in mammals: the kidneys

Values of kidney weight in adult male and female mammals, both terrestrial and aquatic, as well as values for renal blood flow and glomerular number and diameter, were submitted to linear (log-log) regression analysis. The slope of the regression line for kidney weight in 63 species of adult terrestrial mammals was 0.85 %/- 0.01. No statistically significant difference was found between the slopes of the regression lines for male and female terrestrial mammals. The slope of regression line for kidney weight in eight species of adult aquatic mammals was 0.92 +/- 0.01. Again, no statistically significant difference was found between the slopes for males and females. However, the slope (0.92) of the regression line for aquatic mammals was significantly different from the slope (0.85) for terrestrial mammals (P much less than 0.001). The slope of the regression of renal blood flow on body weight was 0.82 +/- 0.01. This value is consistent with the hypothesis that renal blood flow represents a constant fraction of cardiac output (over about 3.4 orders of magnitude in body weight). The slopes of the regression lines for glomerular number (per kidney) and mean glomerular diameter were 0.59 +/- 0.02 and 0.11 +/- 0.01, respectively. A schematic model representing the scaling of energy-partitioning in mammals is introduced.

Intrarenal blood flow, circulation time, and cortical vascular volume in patients with cirrhosis

The pathogenesis of renal functional impairment in patients with cirrhosis is still poorly understood, although it is probably linked to intrarenal haemodynamic alterations, such as renal cortical vasoconstriction and opening of intrarenal shunts. To elucidate the intrarenal haemodynamic pattern in patients with cirrhosis, in eight patients with this disease mean renal blood flow (MRBF) and cortical blood flow (CBF) were determined by means of the xenon-133 washout technique; in the same subjects mean intrarenal circulation time for plasma (t) and fastest circulation time for plasma(t0) were determined by means of injection of human serum albumin tagged with technetium-99m into the renal artery. Moreover, cortical vascular volume (CVV) was obtained in all subjects by means of the following formula: CVV = CBF x t. Fourteen normal subjects constituted a control group for MRBF, 9 subjects for CBF, and 4 subjects for t, t0, and CVV. In patients with cirrhosis MRBF and CBF were significantly less than in controls; t did not show any significant alterations, whereas t0 was significantly shorter than in controls. CVV was also significantly impaired. It is concluded that renal cortical vasoconstriction is a characteristic of the renal haemodynamic pattern in patients with cirrhosis. It is suggested that the decrease in t0 is due to the opening of intrarenal shunts and that is likely to be the consequence of renal vasoconstriction.

Renal distribution volumes of indocyanine green, ( 51 Cr)EDTA, and 24 Na in man during acute renal failure after shock. Implications for the pathogenesis of anuria

The mechanism responsible for the anuria in acute renal failure after shock is still controversial. Suppressed glomerular filtration and/or tubular back-diffusion of the filtrate are major possible causes. In the present investigation, seven patients with acute anuria, three of these seven again in the polyuric phase, six patients with moderate renal impairment, four patients with chronic renal failure, and eight subjects with normal renal function were studied by a multiple indicator-dilution method in which the total renal blood flow and renal distribution volumes of indocyanine green, [(51)Cr]EDTA, and (24)Na were determined. In normal subjects the average values for one kidney were 582 ml/min, 42 ml, 92 ml, and 139 ml, respectively. The measurements in the patients with moderate renal impairment were similar to those in the normal subjects, but were decreased in chronic renal failure. In acute anuria, the average values were 269 ml/min, 40 ml, 101 ml, and 114 ml and the kidney volume, estimated radiographically, was increased by 40%. When expressed as milliliters per milliliters kidney, the average distribution volume of (24)Na was decreased from 0.64 to 0.38. This decrease is consistent with the hypothesis that suppressed filtration is largely responsible for the anuria and that back-diffusion is, at most, a contributory factor. The apparent contradiction between the relatively well-preserved total blood flow and the suppressed filtration may be due to a combination of afferent vasoconstriction and efferent vasodilatation. This view is supported by the observation that low filtration fractions were found in clearance measurements performed during the polyuric phase.