Laboratory of Renal and Body Fluid Physiology, M. Mossakowski Medical Research Centre, Polish Academy of Sciences, Warsaw, Poland.
Kidney Blood Press Res. 2011;34(5):307-10. doi: 10.1159/000328328. Epub 2011 May 23.
Treatment of arterial hypotension with norepinephrine (NE) is associated with renal vasoconstriction and may lead to ischemic kidney injury; the risk involved is still a matter of debate.
In anesthetized, acutely uninephrectomized rats, we examined changes in intrarenal hemodynamics induced by intravenous infusion of NE and angiotensin II (Ang II), at doses that increased arterial pressure by ∼25 mm Hg (20%). Renal blood flow (RBF) was determined using a Transonic probe, and superficial cortical, outer and inner medullary flows (CBF, OMBF, IMBF) as laser-Doppler fluxes.
NE decreased regional intrarenal perfusion similarly, by 16, 15 and 16% for RBF, OMBF and IMBF, respectively (all changes significant). The respective decreases after Ang II were significantly greater and clearly differentiated: 45, 32 and 22%, respectively. The renal vascular resistance increased 47 ± 4% after NE and 131 ± 11% after Ang II, indicating that the latter drug induces much more pronounced renal vasoconstriction.
An ∼15% decrease of renal perfusion may be taken as an indication of an impairment of renal circulation during antihypotensive NE therapy. While superiority of NE over Ang II is obvious, a further search for drugs even less harmful to renal perfusion and function is desirable.
去甲肾上腺素（NE）治疗低血压与肾血管收缩有关，并可能导致肾缺血性损伤；其涉及的风险仍存在争议。
在麻醉、急性单侧肾切除大鼠中，我们检查了静脉输注 NE 和血管紧张素 II（Ang II）引起的肾内血液动力学变化，这些剂量可使动脉压升高约 25mmHg（20%）。使用 Transonic 探头测定肾血流量（RBF），并用激光多普勒通量测定浅层皮质、外髓和内髓血流量（CBF、OMBF、IMBF）。
NE 使局部肾内灌注同样降低，分别为 RBF、OMBF 和 IMBF 降低 16%、15%和 16%（所有变化均有统计学意义）。Ang II 后的相应降低明显更大，且明显不同：分别为 45%、32%和 22%。NE 后肾血管阻力增加 47±4%，Ang II 后增加 131±11%，表明后者诱导的肾血管收缩更为明显。
肾灌注降低约 15%可作为抗低血压 NE 治疗期间肾循环受损的指标。虽然 NE 优于 Ang II 是显而易见的，但仍需要进一步寻找对肾灌注和功能危害更小的药物。
