Division of Nephrology and Hypertension.
Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
J Hypertens. 2019 Oct;37(10):2074-2082. doi: 10.1097/HJH.0000000000002158.
Revascularization does not restore renal function in most patients with atherosclerotic renal artery stenosis (RAS), likely because of inflammation and fibrosis within the stenotic kidney. Low-energy shockwave therapy (LE-SWT) stimulates angiogenesis in the stenotic kidney, but its ability to improve renal function and structure after revascularization remains unexplored. We tested the hypothesis that a LE-SWT regimen before percutaneous transluminal renal angioplasty (PTRA) would enable PTRA to restore renal function in hypercholesterolemic pigs with RAS (HC+RAS), and that this would be associated with attenuation of renal inflammation and fibrosis.
Twenty-six pigs were studied after 16 weeks of HC+RAS, HC+RAS treated with PTRA with or without a preceding LE-SWT regimen (bi-weekly for 3 weeks), and controls. Single-kidney renal blood flow (RBF), glomerular filtration rate (GFR), and oxygenation were assessed in vivo using imaging 4 weeks after PTRA, and then inflammation and fibrosis ex vivo.Four weeks after successful PTRA, blood pressure fell similarly in both revascularized groups. Yet, stenotic-kidney GFR remained lower in HC+RAS and HC+RAS+PTRA (P < 0.01 vs. normal), but was improved in HC+RAS+PTRA+SW (P > 0.05 vs. normal). Furthermore, reduced inflammation, medullary fibrosis, and cortical hypoxia were only shown in swine stenotic kidneys pretreated with LE-SWT before PTRA 4 weeks later.
LE-SWT delivery before revascularization permitted PTRA to improve function and decrease cortical and medullary damage in the stenotic swine kidney. This study, therefore, supports the use of an adjunct SW pretreatment to enhance the success of PTRA in blunting loss of kidney function in experimental HC+RAS.
在大多数患有动脉粥样硬化性肾动脉狭窄（RAS）的患者中，血运重建并不能恢复肾功能，这可能是由于狭窄肾脏内的炎症和纤维化所致。低能量冲击波治疗（LE-SWT）可刺激狭窄肾脏的血管生成，但在血运重建后其改善肾功能和结构的能力仍未得到探索。我们假设，在经皮腔内肾血管成形术（PTRA）之前进行 LE-SWT 治疗方案，将使 PTRA 能够恢复患有 RAS 的高胆固醇血症猪（HC+RAS）的肾功能，并且这将与减轻肾脏炎症和纤维化有关。
在 HC+RAS 后 16 周，对 26 只猪进行了研究，研究对象分别为 HC+RAS 组、HC+RAS 组接受 PTRA 治疗组（伴或不伴先前 LE-SWT 治疗方案，每两周一次，共 3 周）以及对照组。在 PTRA 后 4 周，使用成像技术对单肾肾血流量（RBF）、肾小球滤过率（GFR）和氧合作用进行了体内评估，然后对炎症和纤维化进行了离体评估。在成功进行 PTRA 后 4 周，两组血管再通后的血压下降情况相似。然而，HC+RAS 和 HC+RAS+PTRA 组的狭窄肾脏 GFR 仍然较低（与正常相比，P<0.01），但在 HC+RAS+PTRA+SW 组中有所改善（与正常相比，P>0.05）。此外，只有在 PTRA 之前用 LE-SWT 预处理狭窄的猪肾脏 4 周后，才会显示出炎症减轻、髓质纤维化和皮质缺氧。
在血运重建之前进行 LE-SWT 治疗可以使 PTRA 改善功能，并减少狭窄猪肾脏的皮质和髓质损伤。因此，本研究支持在实验性 HC+RAS 中使用辅助性 SW 预处理来增强 PTRA 减缓肾功能丧失的成功率。
