Contrast-Enhanced Ultrasonography Enables the Detection of a Cold Pressor Test-Induced Increase in Renal Microcirculation in Healthy Participants

Hendriks-Balk, Mariëlle C.; Damianaki, Aikaterini; Polychronopoulou, Erietta; Brito, Wendy; Pruijm, Menno; Wuerzner, Grégoire

doi:10.3389/fcvm.2022.899327

Cited by 4 publications

(5 citation statements)

References 36 publications

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“…Limitations of our study include the unexpected large inter-individual differences in PI (SD > 50% than initially estimated), which makes our study underpowered to fully assess the determinants influencing the PI. Whether this can be explained by differences in systemic and intra-renal RAAS activity, unknown other clinical variables such as the degree of expression of AT1 and AT2 receptors, the integrity of the endothelium or renal sympathetic system activation is still an open question and should be accounted for in future studies [ 14 , 32 , 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

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Determinants of Renal Micro-Perfusion as Assessed with Contrast-Enhanced Ultrasound in Healthy Males and Females

Trillig

Damianaki

Hendriks-Balk

et al. 2023

JCM

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(1) Background: The renal microcirculation is essential to maintain the renal function, but its determinants in humans have been poorly studied. Contrast-enhanced ultrasound (CEUS) allows the non-invasive quantification of the cortical micro-perfusion at the bedside using the perfusion index (PI). The aims of this study were to assess whether differences exist in PI between healthy males and females and to identify clinical determinants associated with cortical micro-perfusion. (2) Methods: Healthy, normotensive volunteers (eGFR > 60 mL/min/1.73 m2, no albuminuria) underwent CEUS under standardized conditions with the destruction–reperfusion (DR) technique. The mean PI of four DR sequences was reported as the primary outcome measure (3) Results: A total of 115 subjects (77 females and 38 males) completed the study; the mean ± SD age was, respectively, 37.1 ± 12.2 and 37.1 ± 12.7 years in females and males, and the mean eGFR was 105.9 ± 15.1 and 91.0 ± 17.4 mL/min/1.73 m2. The PI (median) was higher in females than in males, i.e., 2705 (IQR 1641–3777) vs. 1965 (IQR 1294–3346) arbitrary units (a.u), p = 0.02). A correlation analysis showed positive associations between PI and eGFR, female sex, heart rate, plasma renin activity (PRA) and plasma aldosterone concentrations (PAC), negative associations with potassium, bicarbonate and systolic blood pressure, and no associations with age, body mass index and renal resistive index (RRI). In a multivariate linear regression analysis, only PRA remained significantly associated with PI. (4) Conclusions: Although the PI was higher among females, this association was no longer significant after adjustment for covariates. There was no difference in females tested during the follicular or the luteal phases. In conclusion, the PI was only weakly influenced by classic clinical variables, but was positively associated with PRA, suggesting that the renin–angiotensin system plays a role in the regulation of the cortical micro-perfusion in humans. Identifying which other factors contribute to the large variations in micro-perfusion across individuals needs further study.

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Section: Discussionmentioning

confidence: 99%

“…None of the healthy volunteers participated to both studies. Details of the two studies have been described previously [12,14]. In brief, the inclusion criteria for all the healthy controls in both studies were: age ≥ 18 years, being normotensive (office blood pressure < 135/85 mmHg) and not taking any medications.…”

Section: Study Populationmentioning

confidence: 99%

Determinants of Renal Micro-Perfusion as Assessed with Contrast-Enhanced Ultrasound in Healthy Males and Females

Trillig

Damianaki

Hendriks-Balk

et al. 2023

JCM

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“…A modified CPT was applied as previously described [ 7 ]. Both feet were placed in a footbath filled with water at body temperature (35–37°C, sham) for baseline measurements.…”

Section: Methodsmentioning

confidence: 99%

“…Renal ultrasound was performed on a Samsung RS80A device using a dedicated abdominal probe (3–5 MHz) as described previously [ 7 ]. The RRI was measured in a segmental artery with the easiest accessibility and highest quality of waveforms, and in expiratory breath-hold.…”

Section: Methodsmentioning

confidence: 99%

Contrast-enhanced ultrasonography reveals a lower cortical perfusion and a decreased renal flow reserve in hypertensive patients

Damianaki

Hendriks-Balk

Brito

et al. 2023

Nephrology Dialysis Transplantation

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Background Microvascular structural alteration and dysfunction is a hallmark of arterial hypertension. So far, the visualization and the quantification of renal microcirculation in humans has been hampered by the lack of non-nephrotoxic and non-invasive radiologic techniques. Contrast-Enhanced ultrasonography (CEUS) is an alluring method to investigate renal microcirculation and has not been investigated in this setting. We aimed to compare renal microcirculation in normotensives (NT) and hypertensive (HT) participants using CEUS at rest and during a sympathetic stress test. Methods We measured the renal perfusion index (PI, primary outcome), the renal resistive index (RRI), beat-to-beat systemic hemodynamics and plasma catecholamines before and during a 2-minute cold pressor test (CPT) in NT and HT participants. Linear mixed model analysis was used to compare the effect of the CPT on the variables of interest. Results 73 participants (32 HT) with normal kidney function were included. HT participants had a lower baseline PI compared to NT participants [1476(959–2155) arbitrary unit (a.u.) vs 2062(1438–3318) a.u., p < 0.001]. The CPT increased blood pressure, heart rate and catecholamines in all participants. The increase in PI observed in NT during the CPT was blunted in HT (+504(117–920) a.u. vs + 1159(678–2352) a.u in NT, interaction p = 0.013). Age, sex and body mass index did not modify these results. Conclusions HT patients had a lower basal renal cortical perfusion. During the cold pressor test, HT participants had a smaller increase in the PI, suggesting that renal cortical flow reserve is impaired.

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“…In another study, sympathetic nervous system activity on the external carotid artery (ECA), internal carotid artery (ICA), and middle cerebral artery (MCA) was investigated, and it was shown that the carotid arteries respond to painful stimuli with vasodilation [ 22 ]. On the other hand, a contrast-enhanced Doppler study demonstrated that CPT increases renal microcirculation in healthy individuals [ 23 ]. Studies have also shown that CPT causes coronary vasodilation in healthy individuals [ 24 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of the Cold Pressor Test on Popliteal Vein Diameter, Flow Velocity, and Blood Flow in the Lower Limb in 60 Healthy Individuals

Ege,

Aslanyavrusu,

Uzunok

et al. 2024

Med Sci Monit

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Background:In various situations such as pain, exposure to hot or cold, and mental stress, where physiological stress occurs, the increased excitatory response in the sympathetic efferent neurons leads to an increased return of blood flow from the peripheral veins to the right atrium. The cold pressor test (CPT) is based on the effects of a cold stimulus that activates afferent sensory pathways to trigger a sympathetic response, resulting in an increase in blood pressure. This study aimed to evaluate the effects of the cold pressor test on popliteal vein diameter, flow velocity, and blood flow in the lower limbs in 60 healthy individuals. Material/Methods:We included 30 men and 30 women age 18-40 years. Baseline vein diameter, flow velocity, and blood flow of the left popliteal vein were measured by Doppler ultrasound, then the left hand was immersed in a bucket of cold water. After immersing the hand in cold water for 1 minute (CPT-1), 3 measurements of vein diameter, flow velocity, and blood flow were taken again, and their averages were calculated. Results:In the study, data obtained from the individuals were statistically analyzed. At CPT-1, venous diameter and flow values showed significant increase compared to baseline (P=0.001, P<0.001, respectively). Conclusions:In healthy volunteers, CPT increases venous flow in the popliteal veins. However, our study did not provide evidence for the hypothesis that the increase in venous return is due to venoconstriction mechanisms.

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Contrast-Enhanced Ultrasonography Enables the Detection of a Cold Pressor Test-Induced Increase in Renal Microcirculation in Healthy Participants

Cited by 4 publications

References 36 publications

Determinants of Renal Micro-Perfusion as Assessed with Contrast-Enhanced Ultrasound in Healthy Males and Females

Determinants of Renal Micro-Perfusion as Assessed with Contrast-Enhanced Ultrasound in Healthy Males and Females

Contrast-enhanced ultrasonography reveals a lower cortical perfusion and a decreased renal flow reserve in hypertensive patients

Effects of the Cold Pressor Test on Popliteal Vein Diameter, Flow Velocity, and Blood Flow in the Lower Limb in 60 Healthy Individuals

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