PMID- 32546595 OWN - NLM STAT- MEDLINE DCOM- 20210302 LR - 20210802 IS - 1533-3450 (Electronic) IS - 1046-6673 (Print) IS - 1046-6673 (Linking) VI - 31 IP - 8 DP - 2020 Aug TI - Estimation of Intraglomerular Pressure Using Invasive Renal Arterial Pressure and Flow Velocity Measurements in Humans. PG - 1905-1914 LID - 10.1681/ASN.2019121272 [doi] AB - BACKGROUND: Glomerular hyperfiltration resulting from an elevated intraglomerular pressure (Pglom) is an important cause of CKD, but there is no feasible method to directly assess Pglom in humans. We developed a model to estimate Pglom in patients from combined renal arterial pressure and flow measurements. METHODS: We performed hemodynamic measurements in 34 patients undergoing renal or cardiac angiography under baseline conditions and during hyperemia induced by intrarenal dopamine infusion (30 mug/kg). For each participant during baseline and hyperemia, we fitted an adapted three-element Windkessel model that consisted of characteristic impedance, compliance, afferent resistance, and Pglom. RESULTS: We successfully analyzed data from 28 (82%) patients. Median age was 58 years (IQR, 52-65), median eGFR was 95 ml/min per 1.73 m(2) (IQR, 74-100) using the CKD-EPI formula, 30% had microalbuminuria, and 32% had diabetes. The model showed a mean Pglom of 48.0 mm Hg (SD=10.1) at baseline. Under hyperemia, flow increased by 88% (95% CI, 68% to 111%). This resulted in a 165% (95% CI, 79% to 294%) increase in afferent compliance and a 13.1-mm Hg (95% CI, 10.0 to 16.3) decrease in Pglom. In multiple linear regression analysis, diabetes (coefficient, 10.1; 95% CI, 5.1 to 15.1), BMI (0.99 per kg/m(2); 95% CI, 0.38 to 1.59), and renal perfusion pressure (0.42 per mm Hg; 95% CI, 0.25 to 0.59) were significantly positively associated with baseline Pglom. CONCLUSIONS: We constructed a model on the basis of proximal renal arterial pressure and flow velocity measurements that provides an overall estimate of glomerular pressure and afferent and efferent resistance in humans. The model provides a novel research technique to evaluate the hemodynamics of CKD on the basis of direct pressure and flow measurements. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: Functional HEmodynamics in patients with and without Renal Artery stenosis (HERA), NL40795.018.12 at the Dutch national trial registry (toetsingonline.nl). CI - Copyright (c) 2020 by the American Society of Nephrology. FAU - Collard, Didier AU - Collard D AUID- ORCID: 0000-0001-8572-8751 AD - Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands. FAU - van Brussel, Peter M AU - van Brussel PM AD - Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands. FAU - van de Velde, Lennart AU - van de Velde L AUID- ORCID: 0000-0001-8804-8671 AD - Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands. AD - Faculty of Science and Technology, Technical Medical Centre, Multi-Modality Medical Imaging Group, University of Twente, Enschede, The Netherlands. FAU - Wijntjens, Gilbert W M AU - Wijntjens GWM AD - Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands. FAU - Westerhof, Berend E AU - Westerhof BE AUID- ORCID: 0000-0003-4753-2461 AD - Faculty of Science and Technology, Technical Medical Centre, Cardiovascular and Respiratory Physiology, University of Twente, Enschede, The Netherlands. FAU - Karemaker, John M AU - Karemaker JM AD - Department of Medical Biology, Section Systems Physiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands. FAU - Piek, Jan J AU - Piek JJ AD - Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands. FAU - Reekers, Jim A AU - Reekers JA AD - Department of Radiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands. FAU - Vogt, Liffert AU - Vogt L AUID- ORCID: 0000-0002-4585-7505 AD - Department of Nephrology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands. FAU - de Winter, Robbert J AU - de Winter RJ AD - Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands. FAU - van den Born, Bert-Jan H AU - van den Born BH AD - Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands b.j.vandenborn@amsterdamumc.nl. LA - eng SI - NTR/NL40795.018.12 PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20200616 PL - United States TA - J Am Soc Nephrol JT - Journal of the American Society of Nephrology : JASN JID - 9013836 SB - IM CIN - J Am Soc Nephrol. 2021 Jan;32(1):257-258. PMID: 33170135 CIN - J Am Soc Nephrol. 2021 Jan;32(1):256-257. PMID: 33174862 MH - Aged MH - Arterial Pressure/*physiology MH - Blood Flow Velocity MH - Female MH - Glomerular Filtration Rate MH - Humans MH - Kidney Glomerulus/*physiology MH - Male MH - Middle Aged MH - Pressure MH - Renal Artery/*physiology MH - Renal Insufficiency, Chronic/physiopathology PMC - PMC7460915 OTO - NOTNLM OT - glomerular hyperfiltration OT - renal hemodynamics OT - renal hypertension EDAT- 2020/06/18 06:00 MHDA- 2021/03/03 06:00 PMCR- 2021/08/01 CRDT- 2020/06/18 06:00 PHST- 2019/12/10 00:00 [received] PHST- 2020/04/19 00:00 [accepted] PHST- 2020/06/18 06:00 [pubmed] PHST- 2021/03/03 06:00 [medline] PHST- 2020/06/18 06:00 [entrez] PHST- 2021/08/01 00:00 [pmc-release] AID - ASN.2019121272 [pii] AID - 2019121272 [pii] AID - 10.1681/ASN.2019121272 [doi] PST - ppublish SO - J Am Soc Nephrol. 2020 Aug;31(8):1905-1914. doi: 10.1681/ASN.2019121272. Epub 2020 Jun 16.