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Am J Physiol Renal Physiol 277: F312-F318, 1999;
0363-6127/99 $5.00
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Vol. 277, Issue 2, F312-F318, August 1999

PAH extraction and estimation of plasma flow in human postischemic acute renal failure

Geraldine Corrigan1, Deepa Ramaswamy1, Osun Kwon1, F. Graham Sommer2, Edward J. Alfrey3, Donald C. Dafoe3, Richard A. Olshen4, John D. Scandling3, and Bryan D. Myers1

1 Department of Medicine, Division of Nephrology, 2 Diagnostic Radiology, 3 Adult Kidney and Kidney/Pancreas Transplant Program, and 4 Division of Biostatistics, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California 94305

We determined the effect of postischemic injury to the human renal allograft on p-aminohippurate (PAH) extraction (EPAH) and renal blood flow. We evaluated renal function in 44 allograft recipients on two occasions: 1-3 h after reperfusion (day 0) and again on postoperative day 7. On day 0 subsets underwent intraoperative determination of renal blood flow (n = 35) by Doppler flow meter and EPAH (n = 25) by renal venous assay. Blood flow was also determined in another subset of 16 recipients on postoperative day 7 by phase contrast-cine-magnetic resonance imaging, and EPAH was computed from the simultaneous PAH clearance. Glomerular filtration rate (GFR) on day 7 was used to divide subjects into recovering (n = 23) and sustained (n = 21) acute renal failure (ARF) groups, respectively. Despite profound depression of GFR in the sustained ARF group, renal plasma flow was only slightly depressed, averaging 296 ± 162 ml · min-1 · 1.73 m-2 on day 0 and 202 ± 72 ml · min-1 · 1.73 m-2 on day 7, respectively. These values did not differ from corresponding values in the recovering ARF group: 252 ± 133 and 280 ± 109 ml · min-1 · 1.73 m-2, respectively. EPAH was profoundly depressed on day 0, averaging 18 ± 14 and 10 ± 7% in recovering and sustained ARF groups, respectively, vs. 86 ± 6% in normal controls (P < 0.001). Corresponding values on day 7 remained significantly depressed at 65 ± 20 and 11 ± 22%, respectively. We conclude that postischemic injury to the renal allograft results in profound impairment of EPAH that persists for at least 7 days, even after the onset of recovery. An ensuing reduction in urinary PAH clearance results in a gross underestimate of renal plasma flow, which is close to the normal range in the initiation, maintenance, and recovery stages of this injury.

p-aminohippurate extraction; organic anion transport; renal plasma flow; phase contrast-cine-magnetic resonance imaging


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