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2015 ; 128
(6
): 750-4
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Decrease of glomerular filtration rate may be attributed to the microcirculation
damage in renal artery stenosis
#MMPMID25758267
Dong HJ
; Huang C
; Luo DM
; Ye JG
; Yang JQ
; Li G
; Luo JF
; Zhou YL
Chin Med J (Engl)
2015[Mar]; 128
(6
): 750-4
PMID25758267
show ga
BACKGROUND: The decrease of glomerular filtration rate has been theoretically
supposed to be the result of low perfusion in renal artery stenosis (RAS). But
the gap between artery stenosis and the glomerular filtration ability is still
unclear. METHODS: Patients with selective renal artery angiogram were divided by
the degree of renal artery narrowing, level of estimated glomerular filtration
rate (eGFR), respectively. The different levels of eGFR, renal microcirculation
markers, and RAS severity were compared with each other, to determine the
relationships among them. RESULTS: A total of 215 consecutive patients were
enrolled in the prospective cohort study. Concentrations of microcirculation
markers had no significant difference between RAS group (RAS ? 50%) and no RAS
group (RAS < 50%) or did not change correspondingly to RAS severity. The value of
eGFR in RAS group was lower than that in the no RAS group, but it did not decline
parallel to the progressive severity of RAS. The microcirculation markers
presented integral difference if grouped by different eGFR level with negative
tendency, especially that plasma cystatin C (cysC) and urinary microalbumin to
creatinine ratio (mACR) increased with the deterioration of eGFR, with strong (r
= -0.713, P < 0.001) and moderate (r = -0.580, P < 0.001) correlations. In the
subgroup analysis of severe RAS (RAS ? 80%), the levels of plasma cysC and
urinary mACR demonstrated stronger negative associations with eGFR, (r = -0.827,
P < 0.001) and (r = -0.672, P < 0.001) correlations, respectively. CONCLUSIONS:
Severity of RAS could not accurately predict the value of eGFR, whereas
microcirculation impairment may substantially contribute to the glomerular
filtration loss in patients with RAS.