Kawakami Shotaro, Yasuno Tetsuhiko, Matsuda Takuro, Fujimi Kanta, Ito Ai, Yoshimura Saki, Uehara Yoshinari, Tanaka Hiroaki, Saito Takao, Higaki Yasuki
Department of Rehabilitation, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka, 818-0067, Japan.
Division of Nephrology and Rheumatology, Department of Internal Medicine, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Johnan-ku, Fukuoka, 814-0133, Japan.
Clin Exp Nephrol. 2018 Oct;22(5):1061-1068. doi: 10.1007/s10157-018-1559-1. Epub 2018 Mar 10.
High-intensity exercise reduces renal blood flow (RBF) and may transiently exacerbate renal dysfunction. RBF has previously been measured invasively by administration of an indicator material; however, non-invasive measurement is now possible with technological innovations. This study examined variations in RBF at different exercise intensities using ultrasound echo.
Eight healthy men with normal renal function (eGFR 114 ± 19 mL/min/1.73 m) participated in this study. Using a bicycle ergometer, participants underwent an incremental exercise test using a ramp protocol (20 W/min) until exhaustion in Study 1 and the lactate acid breaking point (LaBP) was calculated. Participants underwent a multi-stage test at exercise intensities of 60, 80, 100, 120, and 140% LaBP in Study 2. RBF was measured by ultrasound echo at rest and 5 min after exercise in Study 1 and at rest and immediately after each exercise in Study 2. To determine the mechanisms behind RBF decline, a catheter was placed into the antecubital vein to study vasoconstriction dynamics.
RBF after maximum exercise decreased by 51% in Study 1. In Study 2, RBF showed no significant decrease until 80% LaBP, and showed a significant decrease (31%) at 100% LaBP compared with at rest (p < 0.01). The sympathetic nervous system may be involved in this reduction in RBF.
RBF showed no significant decrease until 80% LaBP, and decreased with an increase in blood lactate. Reduction in RBF with exercise above the intensity at LaBP was due to decreased cross-sectional area rather than time-averaged flow velocity.
高强度运动可降低肾血流量(RBF),并可能短暂加剧肾功能不全。此前RBF是通过给予指示物质进行有创测量的;然而,随着技术创新,现在已经可以进行无创测量。本研究使用超声回声检查不同运动强度下RBF的变化。
8名肾功能正常(估算肾小球滤过率[eGFR]为114±19毫升/分钟/1.73平方米)的健康男性参与了本研究。在研究1中,参与者使用自行车测力计,采用斜坡方案(20瓦/分钟)进行递增运动试验直至力竭,并计算乳酸突破点(LaBP)。在研究2中,参与者在60%、80%、100%、120%和140%LaBP的运动强度下进行多级试验。在研究1中,于静息时和运动后5分钟通过超声回声测量RBF;在研究2中,于静息时和每次运动后立即测量RBF。为确定RBF下降背后的机制,将导管插入肘前静脉以研究血管收缩动力学。
在研究1中,最大运动后RBF下降了51%。在研究2中,RBF在80%LaBP之前无显著下降,与静息时相比,在100%LaBP时显著下降(31%)(p<0.01)。交感神经系统可能参与了RBF的这种降低。
RBF在80%LaBP之前无显著下降,并随血乳酸增加而降低。运动强度高于LaBP时RBF的降低是由于横截面积减小而非时间平均流速降低。