Use of the Xenon-133 Washout Technique in Diagnosing Renovascular Disease in Hypertension

Leeuw, Peter W. de; Wh, Birkenhäger

doi:10.1159/000184036

Cited by 12 publications

(9 citation statements)

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“…In addition, we sampled blood for the determination of fasting glucose, serum creatinine, and lipid profile. Subsequently, we measured selective MRBF using the 133 Xe washout technique, as previously described (12,23,51). After an intra-arterial administration of 133 Xe (IDB Holland, Baarle-Nassau, The Netherlands) into the renal artery, we measured the disappearance of 133 Xe from the kidney by an extracorporeal scintillation counter during 180 s. Subsequently, the obtained 133 Xe washout curves of the left and right kidney were analyzed offline (using Graphpad Prism 5, Graphpad Software, San Diego, CA).…”

Section: Methodsmentioning

confidence: 99%

Reduced renal plasma clearance does not explain increased plasma asymmetric dimethylarginine in hypertensive subjects with mild to moderate renal insufficiency

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et al. 2012

American Journal of Physiology-Renal Physiology

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PW, Kroon AA. Reduced renal plasma clearance does not explain increased plasma asymmetric dimethylarginine in hypertensive subjects with mild to moderate renal insufficiency. Am J Physiol Renal Physiol 303: F149 -F156, 2012. First published May 2, 2012 doi:10.1152/ajprenal.00045.2012.-Plasma concentrations of the nitric oxide synthase inhibitor asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) increase already in the early stages of renal insufficiency. There is no agreement as to whether reduced renal plasma clearance (RPCL) contributes to this increase. Therefore, we investigated the relationship between estimated glomerular filtration rate (eGFR), RPCL, and plasma ADMA and SDMA in essential hypertensive patients with mild to moderate renal insufficiency. In 171 patients who underwent renal angiography, we drew blood samples from the aorta and both renal veins and measured mean renal blood flow (MRBF) using the 133 Xe washout technique. RPCL was calculated using arteriovenous concentration differences and MRBF. After correction for potential confounders, reduced eGFR was associated with higher plasma ADMA and SDMA [standardized regression coefficient (␤) ϭ Ϫ0.22 (95% confidence intervals: Ϫ0.41, Ϫ0.04) and ␤ ϭ Ϫ0.66 (95% confidence intervals: Ϫ0.83, Ϫ0.49), respectively]. However, eGFR was not independently associated with RPCL of ADMA. Moreover, reduced RPCL of ADMA was not associated with higher plasma ADMA. Contrary to ADMA, reduced eGFR was indeed associated with lower RPCL of SDMA [␤ ϭ 0.21 (95% confidence intervals: 0.02, 0.40)]. In conclusion, our findings indicate that RPCL of ADMA is independent of renal function in hypertensive patients with mild to moderate renal insufficiency. Unlike the case for SDMA, reduced RPCL of ADMA is of minor importance for the increase in plasma ADMA in these patients, which indicates that increased plasma ADMA in this population is not a direct consequence of the kidneys failing as a plasma ADMA-regulating organ. dimethylarginines; renal function; hypertension IN PATIENTS with chronic kidney disease (CKD), the endogenous nitric oxide synthase inhibitor asymmetric dimethylarginine (ADMA) and its structural isomer symmetric dimethylarginine (SDMA) build up in plasma even in the early stages of renal insufficiency (10,19,21). Moreover, ADMA already rises in incipient CKD. The exact mechanisms responsible for this increase of ADMA and SDMA at these early stages of CKD have not been totally clarified but are likely to involve changes in the regulation of the plasma concentration by the kidneys' renal plasma clearance (RPCL) (37,49).The kidneys play an important role in the plasma concentration regulation of ADMA and SDMA. By measuring arteriovenous concentration differences, a previous study (37) demonstrated that the kidneys clear substantial amounts of ADMA and SDMA from the circulation. Furthermore, both dimethylarginines are excreted in the urine in amounts, which are dependent on the glomerular filtration rate (GFR) (2,30,31,49). However, the main...

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Section: Methodsmentioning

confidence: 99%

Reduced renal plasma clearance does not explain increased plasma asymmetric dimethylarginine in hypertensive subjects with mild to moderate renal insufficiency

Ronden

Houben

Teerlink

et al. 2012

American Journal of Physiology-Renal Physiology

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“…In a subgroup of the patients, we also measured arterial and venous osteocalcin. Blood sampling was followed by selective measurements of renal blood flow by means of the 133 xenon washout technique (18)(19)(20). Angiography was performed only after all measurements had been completed in order to avoid disturbing renal hemodynamics or tubular function by the contrast material.…”

Section: Angiography and Samplingmentioning

confidence: 99%

“…Mean renal blood flow (MRBF) was determined by means of the 133 xenon-washout technique, as described previously (20,24). Flow data were analyzed for both the right and the left kidney separately and expressed in mL/min/100 g of renal tis- …”

Section: Calculationsmentioning

confidence: 99%

Renal Handling of Matrix Gla-Protein in Humans with Moderate to Severe Hypertension

et al. 2008

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“…Subsequently, we measure selective mean renal blood flow (MRBF) by means of the 133 Xenon washout technique, 2,3 as described previously. 4,5 As a matter of routine, we start 133 Xenon washout studies in the left kidney, and the whole Xenon-wash-out procedure for both kidneys is completed within approximately 10 minutes. Blood pressure and heart rate are monitored during the MRBF measurements, and no contrast material is administered before the flow studies have been completed.…”

Section: Study Protocolmentioning

confidence: 99%

Asymmetry of Renal Blood Flow in Patients With Moderate to Severe Hypertension

et al. 2003

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Abstract-It is generally assumed that renal blood flow is symmetric in the absence of renal artery stenosis. The aim of the present study was to evaluate whether this is really the case. From a group of consecutive hypertensive patients who had undergone renal angiography, we selected those with patent renal arteries. In all of them selective renal blood flow (RBF) measurements ( 133 Xenon washout technique) had been performed with blood sampling from aorta and both renal veins (nϭ148). Asymmetry of RBF, defined as Ն25% difference in RBF between left and right kidney, was present in 51% of the patients. Subjects with and without asymmetry did not differ in age, body mass index, blood pressure, creatinine clearance, renal volume, or activity of the renin-angiotensin system. The presence of asymmetry coincided with an increased rate of false-positive results on renal scintigraphy. Preliminary data suggest that there may be a relation between asymmetry and renal sympathetic nerve activity. This study demonstrates that asymmetry of RBF is a frequent finding in essential hypertension, which may confound the results of diagnostic tests for renal artery stenosis. Furthermore, the present results underscore the importance of studying the function of both kidneys separately, because it cannot be assumed that they are functionally equal.

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Use of the Xenon-133 Washout Technique in Diagnosing Renovascular Disease in Hypertension

Cited by 12 publications

References 5 publications

Reduced renal plasma clearance does not explain increased plasma asymmetric dimethylarginine in hypertensive subjects with mild to moderate renal insufficiency

Reduced renal plasma clearance does not explain increased plasma asymmetric dimethylarginine in hypertensive subjects with mild to moderate renal insufficiency

Renal Handling of Matrix Gla-Protein in Humans with Moderate to Severe Hypertension

Asymmetry of Renal Blood Flow in Patients With Moderate to Severe Hypertension

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