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Alterations in Vascular Function and Morphology in Acute Ischemic Renal Failure

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Alterations in Vascular Function and Morphology in Acute Ischemic Renal Failure View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Kidney International, Vol. 23 (1983), pp. 717—724 Alterations in vascular function and morphology in acute ischemic renal failure ERVE MATTHYS, MARSHA K. PATTON, RICHARD W. OsGooD, MANJERI A. VENKATACHALAM, and JAY H. STEIN Departments of Medicine and Pathology, University of Texas Health Science Center, San Antonio, Texas Alterations in vascular function and morphology in acute ischemic [2—4]. The mechanisms responsible for the loss of autoregu- renal failure. Left renal arteries of rats were clamped for 40 mm, and the latory ability in ARF are not clear. The vascular response to kidneys were studied 48 hr and 7 days following restoration of blood flow. At 48 hr, there was severe oliguria or anuria. Renal blood flow vasoactive stimuli was reported to be normal in the dog study; it (RBF) was in the normal range, but there was a loss of RBF autoregula- was suggested that a major defect in the vascular contractile tion between 95 to 120 mm of mercury in seven out of nine rats. elements is not responsible for impaired autoregulation [2]. Morphologically, arcuate and interlobular arteries and afferent arteri- However, degenerative vascular lesions have been described in oles showed focal, segmental necrosis of smooth muscle cells andischemic renal injury [5—7], and because in rats with norepi- diapedesis of red blood cells across their walls. At 7 days, renal function was still severely depressed. RBF showed a slight decrease that did not nephrine-induced ARF the response to both vasoconstrictive reach statistical significance, and RBF autoregulatory capacity was lost and vasodilative stimuli was decreased [8], structural damage to in 8 out of 11 rats. Morphologically, vascular lesions were characterized the renal vasculature cannot be excluded as the cause for at this stage by marked thickening and fibrosis of the tunica adventitia of the interlobular arteries and afferent arterioles. Structural vascular impaired autoregulation. alterations may impair smooth muscle contractile function and thus interfere with RBF autoregutatory function in this model of acute renal Methods failure. The studies were performed in male albino Sprague-Dawley rats weighing 300 to 350 g with free access to standard labora- Alterations de Ia fonction et de Ia morphologie vasculaires dans l'insuffisance rénale aigue ischemique. Les artères rénales gauches de tory chow and tap water. rats ont été clampées pendant 40 mm, et les reins étudiés 48 hr et 7jours Functional studies. The rats were anesthetized by intraperi- après La restauration du flux sanguin. A 48 hr II y avait une oligurie toneal injection of sodium pentobarbital (60 mg/kg body sévère ou une anurie. Le flux sanguin renal (RBF) était dans les limites weight), and they were placed on a heating table to maintain de la normale, mais il y avait une perte de l'autorégulation du RBF entre 95 a 120 mm Hg chez sept des neuf rats. Morphologiquement, les body temperature between 37 to 38°C. The left renal artery was artères arquees et interlobulaires et les arterioles afférentes avaient une exposed via a small abdominal incision and clamped (Codman nécrose focale et segmentaire des cellules musculaires lisses, et une clamp 19-8092) for 40 mm. Afterwards, the abdominal incision diapedese des globules rouges a travers leurs parois. A 7 jours, Ia was closed and the animals were allowed to recover with free fonction rénale était encore sévèrement altérée. 11 existait une diminu- access to food and water. Control rats underwent only a sham tion modérée du RBF, n'atteignant pas Ia significativite, et Ia capacité d'autoregulation du RBF était perdue chez 8 des 11 rats. Morpholo- operation without occlusion of the left renal artery. giquement, les lesions vasculaires étaient caractérisëes a cc stade par Forty-eight hours and 7 days, respectively, after the renal un épaississement marqué et une fibrose de Ia tunique adventitielle des artery occlusion, the rats were again anesthetized with an artères interlobulaires et des arterioles afférentes. Les alterationsintraperitoneal injection of sodium pentobarbital (60 mg/kg structurelles vasculaires pourraient altérer Ia fonction contractile mus culaire lisse et interferer ainsi avec la capacité d'autoregulation du RBF body weight) and placed on a heating table. A catheter (PE 50) dans ce modéle d'insuffisance rénale aigue. was inserted in the right jugular vein for administration of Ringer's solution (0.02 mI/mm) and anesthetic as needed. A tracheostomy was performed. The mean arterial blood pressure (MABP) was monitored via a PE 50 catheter placed in the right Recent studies of renal tissue samples from patients with femoral artery attached to a pressure transducer (Statham 23 ischemic acute renal failure (ARF) indicate that tubular necrosis Db). APE 10 catheter was inserted in the left ureter and a PE 50 in human ARF is an on-going process and that the maintenance catheter in the bladder for urine collections from the left and of ARF may be accompanied by intermittent additional insults right kidney, respectively. Only those rats with a MABP equal such as repeated ischemic episodes [1]. Such episodic on-going necrosis could be explained by a loss of RBF autoregulation, so that the kidneys are unable to protect themselves against changes in perfusion pressure and are at a risk of further ischemic damage if perfusion pressure falls. Received for publication July 2, 1982 In this regard, several investigators recently reported the loss and in revised form October 8, 1982 of renal blood flow autoregulation in different models of ARF © 1983 by the International Society of Nephrology 717 718 MatthvsCt (II Table1. Relationshipbetween absolute RBF (mI/mm) and RPP (mm Hg) in the control and experimental groups RPP mmHg 75 80 85 90 95 tOO 105 110 115 120 Control 3.89 4.07 4.43 4.79 4.90 4.92 4.97 4.99 5.04 5.13 N =9 Group A 3.16 3.61 3.80 3.93 4.16 4.25 4.50 4.64 4.83 5.04 N =7 Group B 2.34 2.73 2.88 3.04 3.24' 3.38 3.53' 3.73' 3.85 4.04 N=8 Symbol: Numbers preceded by the reflect the SEM. Data are <0.05 versus control. hyde in 0.1 M Na cacodylate buffer. The kidneys were perfused 6.0 0 at a pressure of 120 mm Hg until a complete washout of the 5.0 i--1- .-J-—J Control group vascular tree was observed 9J. S Thekidneys were then processed for light and electron a --jGrouPA 0 4.0 Group B microscopy. Cross sections were taken for paraffin embedding C I and the sections were stained with hematoxylin and eosin and 0 I .0 3.0 Masson's trichrome stain for connective tissue. In some cases, C Ii the rest of the kidneys were immersed in fixative (1.25% 2.0 glutaraldehyde in 0.1 54Nacacodylate) for 4 hr. Cortical and medullary samples of different parts of the kidneys were 75 80 85 90 95 100 105 110 115 postfixed in osmium tetroxide for 90 mm and processed for Renalperfusion pressure, mmHg embedding in Epon 812. Epon sections (1- to 2-rm thick) were Fig.1. Relationship between the absolute RBF (mI/mm) andRPP(mm stained with 1% toluidine blue in 1% aqueous borax for light Hg) for the three groups. Means are SEM. The broken line represents microscopy. Epon-embedded thin sections (500 to 1000 A) were the best determined linear regression line between 120 and 95 mm Hg cut with a diamond knife, stained with uranyl acetate and lead (see Results). nitrate, and examined in a Philips 301 electron microscope. From each kidney, four blocks with cortical tissue were cut and examined. to or higher than 120 mm Hg were studied. Ten percent inulin in Ringer's solution was infused via the jugular vein catheter at Groups of rats studied 0.02 mI/mm. After an equilibration time of I hr. GFR was Control group. Sham-operated rats 48 hr and 7 days, respec- measured over two cJearance periods of 30 mm each. tively, after the surgical procedure. Since both functional and To obtain the autoregulation curves, a 000 silk suture wasmorphological results were similar in these rats, all these placed around the aorta above both renal arteries. A short pieceanimals were pooled in one control group (N =12).Light and of PE 160 tubing was slipped over the suture. The tubing waselectron microscopic studies were done in 12 and 7 rats, then gradually compressed against the aorta for regulation ofrespectively; functional and autoregulatory data were obtained the renal perfusion pressure (RPP). Renal perfusion pressurein 9 rats. was equated with femoral arterial pressure. The left artery was Group A. Clamped rats, 48 hr after the occlusion of the renal freed from all surrounding tissue. Renal blood flow (RBF) wasartery for 40' (N =12).Light and electron microscopic studies then monitored with a small diameter (2.0-mm circumference)were done in 12 and 5 rats, respectively. Clearance studies were flow transducer connected to a square wave electromagneticimpossible due to severe oligo-anuria. Autoregulation curves flow meter (Carolina Instruments, King, North Carolina) placedwere obtained in 9 of the 12 rats. around the left renal artery, near its origin at the aorta. The RPP Group B. Clamped rats, 7 days after occlusion of the renal was then gradually reduced by steps of 5 mm Hg down to 75 mmartery for 40' (N =18).In 18 rats, light microscopic studies Hg. At each step, the RBF was recorded. Thereafter, a pres-were performed and electron microscopic studies in four.
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