| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH |
|
|
|
|||||||
|
|||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Articles in PresS, published online ahead of print August 15, 2001
Am J Physiol Renal Physiol, 10.1152/ajprenal.0068.2001
Submitted on February 27, 2001
Accepted on August 8, 2001
1 Divison of Nephrology, Stanford University School of Medicine, Stanford, CA, USA
2 Division of Biostatistics, Department of Health Research Policy, Stanford, CA, USA
3 Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
4 Department of Transplant Medicine, Stanford University School of Medicine, Stanford, CA, USA
5 Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
6 Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
* To whom correspondence should be addressed. E-mail: h.takagishi{at}leland.stanford.edu.
Postischemic injury in 38 recipients of 7 day old cadaveric, renal allografts was classified into sustained (N=15) or recovering (N=23) acute renal failure (ARF) according to the prevailing inulin clearance. Recipients of long-standing allografts that functioned optimally(N=16) and living transplant donors undergoing nephrectomy (N=10) served as functional and structural controls, respectively. A combination of physiological and morphometric techniques were used to evaluate GFR and its determinants 1-3 hr after reperfusion and again on day 7, so as to elucidate the mechanism for persistent hypofiltration in ARF that is sustained. Mean (±lSD) GFR in the sustained ARF group on day 7 was depressed by 90% below control levels, 8±8 vs 80±20 ml/min. The corresponding fall in renal plasma flow was smaller, such that filtration fraction averaged only 4±4% vs 22±5% in controls (p<0.001). Neither plasma oncotic pressure nor the single nephron ultrafiltration coefficient (Kf) differed between the sustained ARF and control groups, however. A model of glomerular ultrafiltration and a sensitivity analysis were used to compute the prevailing transcapillary hydraulic pressure gradient (?P), the only remaining determinant of ?P. This revealed ?P to vary between 25-27 mmHg in sustained ARF vs 47-54 mmHg in controls. In the recovering ARF group GFR increased from 17±11 ml/min on day 0 to 50±20 ml/min on day 7 (p<0.01). This was attributable to a significant increase from day 0 levels in Kf by 30% (p<0.001) combined with elevation of computed ?P form 26-31 to 32-43 mmHg. Sustained and recovering ARF were associated with tubular dilatation that was either persistent or reversible, respectively. We conclude that depression of ?P, perhaps due partially to elevated tubule pressure, is the predominant cause of hypofiltration in the maintenance stage of ARF that is sustained for 7 days.
This article has been cited by other articles:
|
|
 |
|
  J. C. Tan, B. Workeneh, S. Busque, K. Blouch, G. Derby, and B. D. Myers Glomerular Function, Structure, and Number in Renal Allografts from Older Deceased Donors J. Am. Soc. Nephrol., January 1, 2009; 20(1): 181 - 188. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Hladunewich, B. D. Myers, G. C. Derby, K. L. Blouch, M. L. Druzin, W. M. Deen, D. M. Naimark, and R. A. Lafayette Course of preeclamptic glomerular injury after delivery Am J Physiol Renal Physiol, March 1, 2008; 294(3): F614 - F620. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Z. Guan, G. Gobe, D. Willgoss, and Z. H. Endre Renal endothelial dysfunction and impaired autoregulation after ischemia-reperfusion injury result from excess nitric oxide Am J Physiol Renal Physiol, September 1, 2006; 291(3): F619 - F628. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. C. Dagher, S. Herget-Rosenthal, S. G. Ruehm, S.-K. Jo, R. A. Star, R. Agarwal, and B. A. Molitoris Newly Developed Techniques to Study and Diagnose Acute Renal Failure J. Am. Soc. Nephrol., August 1, 2003; 14(8): 2188 - 2198. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. A. Wald, Y. Figueroa, A. S. Oriolo, and P. J. I. Salas Membrane repolarization is delayed in proximal tubules after ischemia-reperfusion: possible role of microtubule-organizing centers Am J Physiol Renal Physiol, August 1, 2003; 285(2): F230 - F240. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Hladunewich, K. V. Lemley, K. L. Blouch, and B. D. Myers Determinants of GFR depression in early membranous nephropathy Am J Physiol Renal Physiol, May 1, 2003; 284(5): F1014 - F1022. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH |
| Visit Other APS Journals Online |
