Assessment of renal perfusion impairment in a rat model of acute renal congestion using contrast-enhanced ultrasonography

Komuro, Kaoru; Seo, Yoshihiro; Yamamoto, Masayoshi; Sai, Seika; Ishizu, Tomoko; Shimazu, Kyo; Takahashi, Yumi; Imagawa, Shogo; Anzai, Teisuke; Yonezawa, Kazuya; Aonuma, Kazutaka

doi:10.1007/s00380-017-1063-7

Cited by 27 publications

(11 citation statements)

References 32 publications

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“…These animal experiments showed that renal perfusion was impaired as the CVP and renal interstitial pressure increase. 15 Similar to the experimental results, the TTP in CHF patients before treatment was significantly prolonged in this study. In the cortex, the TTP was shortened due to the improvement in renal congestion after CHF treatment; this indicates that the perfusion rate of the renal parenchyma was decreased as a result of renal congestion.…”

Section: Renal Perfusion Impairment In Chf Patientssupporting

confidence: 88%

“…36,37 In our previous animal experiments, perfusion impairment due to acute renal congestion was more pronounced in the medulla than in the cortex. 15 Therefore, in the assessment of renal congestion, evaluation of the medullary circulation may be more important than evaluation of the cortical circulation. In the present study, improved blood volume was observed in the cortical and medullary regions, and the perfusion rate of the cortex was restored after CHF treatment.…”

Section: Differences Between the Cortex And Medullamentioning

confidence: 99%

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Demonstration of Improved Renal Congestion After Heart Failure Treatment on Renal Perfusion Imaging With Contrast-Enhanced Ultrasonography

et al. 2019

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including changes in renal perfusion early in the course of renal allograft nephropathy 10,11 and renal artery stenosis. 12 Furthermore, it has been experimentally applied in induced acute kidney injury models. 13, 14 We recently reported that successful visualization of renal perfusion disturbances using CEUS was possible in rat models of acute renal congestion. 15 Based on these results, we hypothesized that human renal congestion could also be evaluated using CEUS.Therefore, in this study, we quantified renal congestion in CHF patients on renal perfusion imaging using CEUS. Methods Study DesignIn total, 11 patients (7 men, 4 women; mean age, 81±8 years) who were hospitalized with a diagnosis of CHF using the Framingham Congestive Heart Failure Diagnostic criteria were enrolled. 16 Obvious symptoms of right-sided HF were recognized in all patients, included leg edema, shortness of breath, pleural effusion, pulmonary hypertension, moderate or severe tricuspid regurgitation (TR), and a decline of inspiratory collapse in the inferior vena cava (IVC). As part of the inclusion criteria for this study, all patients were Background: Renal congestion is a critical pathophysiological component of congestive heart failure (CHF). Methods and Results:To quantify renal congestion, contrast-enhanced ultrasonography (CEUS) was performed at baseline and after treatment in 11 CHF patients and 9 normal subjects. Based on the time-contrast intensity curve, time to peak intensity (TTP), which reflects the perfusion rate of renal parenchyma, and relative contrast intensity (RCI), an index reflecting renal blood volume, were measured. In CHF patients, TTP at baseline was significantly prolonged compared with that in controls (cortex, 10.8±3.5 vs. 4.6±1.2 s, P<0.0001; medulla, 10.6±3.0 vs. 5.1±1.6 s, P<0.0001), and RCI was lower than that in controls (cortex, −16.5±5.2 vs. −8.8±1.5 dB, P<0.0001; medulla, −22.8±5.2 vs. −14.8±2.4 dB, P<0.0001). After CHF treatment, RCI was significantly increased (cortex, −16.5±5.2 to −11.8±4.5 dB, P=0.035; medulla, −22.8±5.2 to −18.7±3.7 dB, P=0.045). TTP in the cortex decreased after treatment (10.8±3.5 to 7.6±3.1 s, P=0.032), but it was unchanged in the medulla (10.6±3.0 to 8.3±3.2 s, P=0.098). Conclusions:Renal congestion can be observed using CEUS in CHF patients.

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Section: Renal Perfusion Impairment In Chf Patientssupporting

confidence: 88%

Section: Differences Between the Cortex And Medullamentioning

confidence: 99%

Demonstration of Improved Renal Congestion After Heart Failure Treatment on Renal Perfusion Imaging With Contrast-Enhanced Ultrasonography

et al. 2019

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“…Recently, a rat model of acute renal congestion has been described by Komuro et al [86]. In this model, the femoral vein was cannulated with an indwelling catheter for the simultaneous monitoring of the CVP and injection of saline to create the acute renal congestion model.…”

Section: Saline Infusionmentioning

confidence: 99%

“…In this model, the femoral vein was cannulated with an indwelling catheter for the simultaneous monitoring of the CVP and injection of saline to create the acute renal congestion model. A bolus of saline is injected until the CVP increased to 10-15 mmHg [86]. However, being an acute model of renal congestion, the chronic phase cannot be investigated and systemic congestion was not induced.…”

Section: Saline Infusionmentioning

confidence: 99%

Current animal models for the study of congestion in heart failure: an overview

et al. 2019

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Congestion (i.e., backward failure) is an important culprit mechanism driving disease progression in heart failure. Nevertheless, congestion remains often underappreciated and clinicians underestimate the importance of congestion on the pathophysiology of decompensation in heart failure. In patients, it is however difficult to study how isolated congestion contributes to organ dysfunction, since heart failure and chronic kidney disease very often coexist in the so-called cardiorenal syndrome. Here, we review the existing relevant and suitable backward heart failure animal models to induce congestion, induced in the left-(i.e., myocardial infarction, rapid ventricular pacing) or right-sided heart (i.e., aorta-caval shunt, mitral valve regurgitation, and monocrotaline), and more specific animal models of congestion, induced by saline infusion or inferior vena cava constriction. Next, we examine critically how representative they are for the clinical situation. After all, a relevant animal model of isolated congestion offers the unique possibility of studying the effects of congestion in heart failure and the cardiorenal syndrome, separately from forward failure (i.e., impaired cardiac output). In this respect, new treatment options can be discovered.

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“…Previous studies have shown that a higher CVP impedes venous return [38,39] and worsens hepatic, renal, splanchnic, and cardiac microcirculatory flow and organ function [40][41][42]. Marik et al even reasons that CVP is the major determinant of organ capillary flow when the middle arterial pressure (MAP) is within an organ s autoregulatory range [40,43].…”

Section: Discussionmentioning

confidence: 99%

High Central Venous Pressure after Cardiac Surgery Might Depict Hemodynamic Deterioration Associated with Increased Morbidity and Mortality

Schiefenhövel

Trauzeddel

Sander

et al. 2021

JCM

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Background: Cardiac surgery patients represent a high-risk cohort in intensive care units (ICUs). Central venous pressure (CVP) measurement seems to remain an integral part in hemodynamic monitoring, especially in cardio-surgical ICUs. However, its value as a prognostic marker for organ failure is still unclear. Therefore, we analyzed postoperative CVP values after adult cardiac surgery in a large cohort with regard to its prognostic value for morbidity and mortality. Methods: All adult patients admitted to our ICUs between 2006 and 2019 after cardiac surgery were eligible for inclusion in the study (n = 11,198). We calculated the median initial CVP (miCVP) after admission to the ICU, which returned valid values for 9802 patients. An ROC curve analysis for optimal cut-off miCVP to predict ICU mortality was conducted with consecutive patient allocation into a (a) low miCVP (LCVP) group (≤11 mmHg) and (b) high miCVP (HCVP) group (>11 mmHg). We analyzed the impact of high miCVP on morbidity and mortality by propensity score matching (PSM) and logistic regression. Results: ICU mortality was increased in HCVP patients. In addition, patients in the HCVP group required longer mechanical ventilation, had a higher incidence of acute kidney injury, were more frequently treated with renal replacement therapy, and showed a higher risk for postoperative liver dysfunction, parametrized by a postoperative rise of ≥ 10 in MELD Score. Multiple regression analysis confirmed HCVP has an effect on postoperative ICU-mortality and intrahospital mortality, which seems to be independent. Conclusions: A high initial CVP in the early postoperative ICU course after cardiac surgery is associated with worse patient outcome. Whether or not CVP, as a readily and constantly available hemodynamic parameter, should promote clinical efforts regarding diagnostics and/or treatment, warrants further investigations.

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Assessment of renal perfusion impairment in a rat model of acute renal congestion using contrast-enhanced ultrasonography

Cited by 27 publications

References 32 publications

Demonstration of Improved Renal Congestion After Heart Failure Treatment on Renal Perfusion Imaging With Contrast-Enhanced Ultrasonography

Demonstration of Improved Renal Congestion After Heart Failure Treatment on Renal Perfusion Imaging With Contrast-Enhanced Ultrasonography

Current animal models for the study of congestion in heart failure: an overview

High Central Venous Pressure after Cardiac Surgery Might Depict Hemodynamic Deterioration Associated with Increased Morbidity and Mortality

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