The Value of the Renal Biopsy in Unilateral Renovascular Hypertension

Barajas, Luciano; Lupu, Andrei N.; Kaufman, Joseph J.; Latta, Harrison; Maxwell, M.H.

doi:10.1159/000179585

Cited by 23 publications

(4 citation statements)

References 5 publications

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“…The mea sured biochemical and functional parameters though can not serve as predictors for recovery, although key meta bolic enzymes were measured. It has been postulated that the degree of tubular atrophy and interstitial scarring inversely correlate to the reversibility of functional im pairment of a kidney with artery stenosis [ 1 ]. This finding has been disputed and at least for tubular atrophy cannot be corroborated in this study.…”

Section: Discussioncontrasting

confidence: 55%

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Characteristics of Renal Tubular Atrophy in Experimental Renovascular Hypertension: A Model of Kidney Hibernation

Gröne

Warnecke

Olbricht

1996

Nephron

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The inability to separate irreversible lesions of tubular epithelia from reversible tubular atrophy constitutes a major problem in histopathology and in decisions for revascularization of shrunken kidneys with renal artery stenosis. In order to characterize reversible tubular atrophy (‘kidney hibernation’) we studied the physiological and biochemical parameters and morphology including histochemistry in rat kidneys made atrophic by renal artery stenosis and treatment with the angiotensin-converting enzyme inhibitor, enalapril. Renal artery stenosis was induced by a 0.2-mm clip around the left renal artery. Following 7 weeks of clipping and 2 concomitant weeks of enalapril treatment, the kidney length decreased from 17.8 ± 0.3 to 13.7 ± 0.7 mm (mean ± SEM). Renal blood flow and glomerular filtration rate decreased to 39 ± 3% and to approximately 3% of control values, respectively. The activities of the intracellular proteolytic enzymes cathepsin B and L and of Na-K-ATPase in microdissected proximal tubular segments decreased to values below 50 and 10%, respectively. All changes were significant (p < 0.05). Histochemical staining for ATPase activity in the distal tubule segments remained unchanged. Tubular cells were atrophic but not necrotic. Histochemical staining of alkaline phosphatase in the tubular brush border and of acid phosphatase and peroxidase in lysosomes was greatly reduced. All observed changes were reversible within 2-3 weeks following removal of the clip and withdrawal of enalapril either with or without contralateral nephrectomy. Thus, a form of kidney hibernation with readily reversible tubular atrophy has been described. Based on this description it may be possible in consecutive experiments to differentiate between reversible and irreversible tubular atrophy.

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Section: Discussioncontrasting

confidence: 55%

“…The phenomenon of hiberna tion seems to play an important role in ischemic heart dis ease and may very well also be of relevance in renovascu lar disease. Decreased blood flow in renal artery stenosis is associated with a decreased size of the kidney and tubu lar atrophy [1][2][3][4][5][6].…”

mentioning

confidence: 99%

Characteristics of Renal Tubular Atrophy in Experimental Renovascular Hypertension: A Model of Kidney Hibernation

Gröne

Warnecke

Olbricht

1996

Nephron

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“…In itself it is not a specific sign. It has been described as a prominent feature in some inherited chronic degenerative disorders of unknown aetiology, eg, juvenile nephronopthisis (Ivemark, Ljungqvist, and Barty, 1960), the kidney disease associated with retinitis pigmentosa (Meier and Hess, 1965), and renal ischaemia from arterial occlusion (Barajas, Lupu, Kaufman, Latta, and Maxwell, 1967), and in the so-called phenacetin kidney'.…”

Section: Discussionmentioning

confidence: 99%

An unusual form of renal disease associated with gout and hypertension

Goor¹,

Kooiker²,

Mees³

1971

J Clin Pathol

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A family is described many of whose members suffered from renal insufficiency, hypertension, gout, and hyperuricaemia in conjunction. Adequate information was obtained on 72 subjects from five generations. In 17, one or more of the above mentioned abnormalities was or had been present. The hereditary distribution suggested an autosomal dominant disease entity.The renal disease was characterized by an early loss of urinary concentrating power, minimal proteinuria, and death at a relatively early age dominating the clinical picture.The histological picture in three biopsies and one necropsy showed predominant tubular atrophy and interstitial fibrosis, with striking tubular basement membrane thickening.It is suggested that these patients suffered from a hereditary degenerative renal disease. The question whether hyperuricaemia was primary or secondary in these cases is discussed.

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“…Other factors, such as coexisting hypertensive and atheroscle-rotic damage to the renal parenchyma (5,6), may be more often important in the pathogenesis of renal failure. For example, the effects of revascularization on renal functional outcome are unpredictable, and this is true irrespective of the nature of the revascularization technique.…”

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confidence: 99%

Epidemiology of Renal Dysfunction and Patient Outcome in Atherosclerotic Renal Artery Occlusion

Cheung

Wright

Shurrab

et al. 2002

Journal of the American Society of Nephrology

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ABSTRACT. Patients with atherosclerotic renal artery occlusion (RAO) effectively have only a single functioning kidney, so they constitute an ideal group in whom to study the relationship of atherosclerotic renovascular disease (ARVD) severity to renal functional outcome. Of 299 patients with ARVD who had presented to a single center over a 12-yr period, 142 (47.5%) patients with RAO were identified. There was no relationship between baseline renal function and contralateral renovascular anatomy. Patients with contralateral normal, insignificant (<50%), or significant (>50%) renal artery stenoses had baseline creatinine of 243 ± 235, 292 ± 197, or 210 ± 102 μmol/L, respectively, but patients with bilateral RAO (creatinine, 540 ± 304 μmol/L; P < 0.0001) were significantly worse. There were significant correlations between baseline GFR and both proteinuria (r = −0.32; P < 0.01) and contralateral bipolar renal length (r = 0.44; P < 0.0001). Over a mean follow-up period of 31 ± 21 (2 to 82) mo, the overall rate of progressive renal functional decline was −4.1 ml/min per yr. Nine patients required dialysis at presentation and a further 15 (10.5%) during the course of the study. There were 85 (59.9%) deaths; median survival of the whole group was 25 mo, and 5-yr survival was 31%. Multivariate analysis indicated that low baseline GFR was the chief variable independently associated with increased probability of death or need of dialysis but that renal vascular anatomy had no prognostic impact. This study reinforces the importance of intrarenal vascular and parenchymal disease in the etiology of renal dysfunction in ARVD.

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The Value of the Renal Biopsy in Unilateral Renovascular Hypertension

Cited by 23 publications

References 5 publications

Characteristics of Renal Tubular Atrophy in Experimental Renovascular Hypertension: A Model of Kidney Hibernation

Characteristics of Renal Tubular Atrophy in Experimental Renovascular Hypertension: A Model of Kidney Hibernation

An unusual form of renal disease associated with gout and hypertension

Epidemiology of Renal Dysfunction and Patient Outcome in Atherosclerotic Renal Artery Occlusion

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