Vink E E, Boer A, Verloop W L, Spiering W, Voskuil M, Vonken E, Hoogduin J M, Leiner T, Bots M L, Blankestijn P J
Department of Nephrology, University Medical Center Utrecht, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.
Eur Radiol. 2015 Jul;25(7):1984-92. doi: 10.1007/s00330-014-3583-1. Epub 2015 Jan 18.
Renal denervation (RDN) is a promising therapy for resistant hypertension. RDN is assumed to decrease sympathetic activity. Consequently, RDN can potentially increase renal oxygenation. Blood oxygen level-dependent MRI (BOLD-MRI) provides a non-invasive tool to determine renal oxygenation in humans. The aim of the current study was to investigate the effect of RDN on renal oxygenation as determined by BOLD-MRI.
Patients with resistant hypertension or the inability to follow a stable drug regimen due to unacceptable side effects were included. BOLD-MRI was performed before and 12 months after RDN. Twenty-seven patients were imaged on 3 T and 19 on 1.5 T clinical MRI systems.
Fifty-four patients were included, 46 patients (23 men, mean age 57 years) completed the study. Mean 24-h BP changed from 163(±20)/98(±14) mmHg to 154(±22)/92(±13) mmHg (p = 0.001 and p < 0.001). eGFR did not change after RDN [77(±18) vs. 79(±20) mL/min/1.73 m(2); p = 0.13]. RDN did not affect renal oxygenation [1.5 T: cortical R2*: 12.5(±0.9) vs. 12.5(±0.9), p = 0.94; medullary R2*: 19.6(±1.7) vs. 19.3(1.4), p = 0.40; 3 T: cortical R2*: 18.1(±0.8) vs. 17.8(±1.2), p = 0.47; medullary R2*: 27.4(±1.9) vs. 26.7(±1.8), p = 0.19].
The current study shows that RDN does not lead to changes in renal oxygenation 1 year after RDN as determined by BOLD-MRI.
• Renal denervation significantly decreased ambulatory blood pressure. • Renal denervation did not change renal oxygenation as determined by BOLD-MRI. • Absence of a change in renal oxygenation might be explained by autoregulation.
肾去神经支配术（RDN）是一种治疗顽固性高血压的有前景的疗法。RDN被认为可降低交感神经活性。因此，RDN可能会增加肾脏氧合。血氧水平依赖性功能磁共振成像（BOLD-MRI）为测定人体肾脏氧合提供了一种非侵入性工具。本研究的目的是通过BOLD-MRI研究RDN对肾脏氧合的影响。
纳入顽固性高血压患者或因不可接受的副作用而无法遵循稳定药物治疗方案的患者。在RDN术前和术后12个月进行BOLD-MRI检查。27例患者在3T临床磁共振成像系统上成像，19例在1.5T临床磁共振成像系统上成像。
共纳入54例患者，46例患者（23例男性，平均年龄57岁）完成研究。平均24小时血压从163（±20）/98（±14）mmHg降至154（±22）/92（±13）mmHg（p = 0.001和p < 0.001）。RDN术后估算肾小球滤过率（eGFR）未发生变化[77（±18）对79（±20）mL/min/1.73 m²；p = 0.13]。RDN未影响肾脏氧合[1.5T：皮质R2*：12.5（±0.9）对12.5（±0.9），p = 0.94；髓质R2*：19.6（±1.7）对·19.3（1.4），p = 0.40；3T：皮质R2*：18.1（±0.8）对17.8（±1.2），p = 0.47；髓质R2*：27.4（±1.9）对26.7（±1.8），p = 0.19]。
本研究表明，RDN术后1年，通过BOLD-MRI测定，RDN不会导致肾脏氧合发生变化。
• 肾去神经支配术显著降低动态血压。• 肾去神经支配术未改变通过BOLD-MRI测定的肾脏氧合。• 肾脏氧合未发生变化可能由自身调节来解释。
