Glazer A A, Inman S R, Stowe N T, Novick A C
Department of Urology, Cleveland Clinic Foundation, OH 44195, USA.
Urology. 1997 Nov;50(5):812-7. doi: 10.1016/S0090-4295(97)00338-5.
Patients with reduced renal mass are at increased risk of developing renal failure. A remnant kidney model has been used to study the hemodynamic and structural changes that occur. We recently reported that the lipid-lowering agent lovastatin preserves renal function in this model. The purpose of the present study was to determine the specific effects of lovastation on the renal microcirculation of rats with reduced renal mass.
We used the rat hydronephrotic kidney preparation with a 5/6 partial nephrectomy. This model allows direct visualization of preglomerular and postglomerular vessels using videomicroscopy. The diameters and vascular responses to acetylcholine and angiotensin II of the interlobular, afferent, and efferent vessels were determined in two groups of animals with renal mass reduction: 15 rats with no lovastatin treatment and 18 rats treated with oral lovastatin (15 mg/kg body weight/day) for 2 weeks.
In the lovastatin-treated rats, the baseline efferent vessel diameter was smaller by 21% (P < 0.05), but the interlobular and afferent vessel baseline diameters were not different from those in the untreated rats. Serum creatinine levels were lower in the treated rats (1.5 +/- 0.1 versus 2.0 +/- 0.2 mg/dL, P < 0.05), but serum lipids were not different. In the lovastatin-treated rats, vascular reactivity to acetylcholine was enhanced in the afferent and decreased in the efferent vessels.
In this renal ablation model, lovastatin preserved renal function as measured by serum creatinine without lowering plasma lipid levels. Lovastatin treatment resulted in smaller efferent vessel diameters. Lovastatin also increased the vasodilatory response to acetylcholine in the afferent vessels. Together, these preglomerular and postglomerular changes would increase the single-nephron glomerular filtration rate. The renal protective effect of lovastatin may be due to these vasoactive effects on the renal microcirculation.
肾质量减少的患者发生肾衰竭的风险增加。已使用残余肾模型来研究发生的血流动力学和结构变化。我们最近报道,降脂药物洛伐他汀在该模型中可保留肾功能。本研究的目的是确定洛伐他汀对肾质量减少大鼠肾微循环的具体影响。
我们使用了进行5/6肾部分切除术的大鼠肾积水肾制备模型。该模型允许使用视频显微镜直接观察肾小球前和肾小球后血管。在两组肾质量减少的动物中,测定小叶间、入球和出球血管的直径以及对乙酰胆碱和血管紧张素II的血管反应:15只未接受洛伐他汀治疗的大鼠和18只口服洛伐他汀(15mg/kg体重/天)治疗2周的大鼠。
在洛伐他汀治疗的大鼠中,出球血管基线直径小21%(P<0.05),但小叶间和入球血管基线直径与未治疗大鼠无差异。治疗大鼠的血清肌酐水平较低(1.5±0.1对2.0±0.2mg/dL,P<0.05),但血脂无差异。在洛伐他汀治疗的大鼠中,入球血管对乙酰胆碱的血管反应增强,出球血管则减弱。
在这个肾切除模型中,洛伐他汀在不降低血浆脂质水平的情况下,以血清肌酐衡量保留了肾功能。洛伐他汀治疗导致出球血管直径变小。洛伐他汀还增加了入球血管对乙酰胆碱的舒张反应。这些肾小球前和肾小球后的变化共同作用会增加单肾单位肾小球滤过率。洛伐他汀的肾脏保护作用可能归因于其对肾微循环的这些血管活性作用。