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J Am Soc Nephrol 10:1455-1465, 1999
© 1999 American Society of Nephrology

REGULAR ARTICLES

Noninvasive Evaluation of a Novel Swine Model of Renal Artery Stenosis

LILACH O. LERMAN*, ROBERT S. SCHWARTZ{dagger}, JOSEPH P. GRANDE{ddagger}, PATRICK F. SHEEDY, II§ and J. CARLOS ROMERO||

* Department of Internal Medicine, Division of Hypertension, Mayo Clinic, Rochester, Minnesota.
{dagger} Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
{ddagger} Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
§ Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minnesota.
|| Department of Physiology and Biophysics, Mayo Clinic, Rochester, Minnesota.

Correspondence to Dr. Lilach O. Lerman, Division of Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. Phone: 507-284-2511; Fax: 507-255-1935; E-mail: lerman.lilach{at}mayo.edu

Abstract. Intrarenal hemodynamics and excretory function distal to renal artery stenosis are difficult to quantify noninvasively. In this study, a swine model of chronic unilateral renal artery stenosis, achieved by implantation of an intravascular device that leads to a gradual and progressive luminal area narrowing, was developed and evaluated. Bilateral cortical and medullary volumes, blood flows, and segmental tubular dynamics were assessed in the intact kidneys of seven pigs using electron-beam computerized tomography before and 1 mo after implantation of the device. Within 1 mo, a 66% angiographic stenosis was significantly correlated with a 25% increase in BP. The volume and blood flow were markedly lower in the stenotic compared with the contralateral kidney and cortex, while the medulla exhibited minimal changes. In the stenotic kidney, intratubular contrast content has decreased in all nephron segments, especially in the distal tubule, where it correlated with an increase in serum creatinine and stenosis severity. In the contralateral kidney, dilution of proximal tubular fluid correlated with the increase in BP, likely due to pressure-natriuresis. In conclusion, the swine model closely resembles human renovascular hypertension. In the stenotic kidney, the hemodynamic impairment of the cortex is dissociated from the relatively preserved renal medulla, and the earliest effect on excretory function is observed in the distal nephron, where the fall in the amount of fluid reaching that segment is directly proportional to the renal arterial compromise. Electron-beam computerized tomography shows promise to noninvasively quantify, follow-up, and study changes in concurrent, in vivo intrarenal hemodynamics and segmental tubular function in renovascular hypertension.




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