Ernst C B, Daugherty M E, Kotchen T A
Surgery. 1976 Aug;80(2):252-8.
Lateralizing renal venous plasma renin activity (RVPRA) ratios offer a predictive index of success of revascularization procedures for renovascular hypertension. Reliance upon nonlateralizing renin ratios to reject functional significance of renal arterial stenosis may deny some patients benefit of successful operations. To test the hypothesis that RVPRA ratios revert toward unity coincident with development of collateral circulation to an ischemic kidney, the relationship between development of collaterals and RVPRA was studied in nine dogs after gradual unilateral renal arterial occlusion with a constrictor. Arterial blood pressure and arteriographic measurement of collateral channels, RVPRA, and renal surface index (RSI) were measured before and during the 10-week interval after constrictor placement. RSI measurements, documenting changes in volume of the renal parenchyma, reflected changes in renal blood flow. Arterial pressure increased in each animal (p less than 0.0009). The number of collateral vessels to the constricted kidney increased with time (p less than 0.01). During the 4 weeks following placement of the constrictors, RSI ratios (constricted: nonconstricted) decreased (p less than 0.003) and RVPRA ratios (constricted: nonconstricted) increased (p less than 0.005). Subsequently, coincident with development of collateral vessels, RSI ratios increased and RVPRA ratios decreased toward control values. These data suggest that absence of lateralizing RVPRA ratios in the presence of collateral vessels does not mean lack of functional significance of stenotic renal arterial lesions.
肾静脉血浆肾素活性（RVPRA）的侧别化比率为肾血管性高血压血管重建手术的成功提供了一个预测指标。依赖非侧别化的肾素比率来否定肾动脉狭窄的功能意义，可能会使一些患者无法从成功的手术中获益。为了验证RVPRA比率会随着缺血肾侧支循环的形成而恢复到统一水平这一假设，在9只狗身上进行了研究，通过用缩窄器逐渐单侧肾动脉闭塞来观察侧支循环的形成与RVPRA之间的关系。在放置缩窄器前及放置后的10周内，测量动脉血压、侧支通道的血管造影测量值、RVPRA和肾表面指数（RSI）。RSI测量记录了肾实质体积的变化，反映了肾血流量的变化。每只动物的动脉血压均升高（p<0.0009）。狭窄肾的侧支血管数量随时间增加（p<0.01）。在放置缩窄器后的4周内，RSI比率（狭窄侧：非狭窄侧）下降（p<0.003），RVPRA比率（狭窄侧：非狭窄侧）升高（p<0.005）。随后，随着侧支血管的形成，RSI比率升高，RVPRA比率下降至对照值。这些数据表明，在存在侧支血管的情况下，RVPRA比率无侧别化并不意味着狭窄性肾动脉病变缺乏功能意义。
