EXPERIMENTAL AND CLINICAL SIGNIFICANCE OF RENAL FUNCTIONAL RESERVE DETERMINATION
Abstract
Background. Renal functional reserve (RFR) is defined as the temporary increase in glomerular filtration rate (GFR) which follows the ingestion of proteins or infusion of aminoacids. This renal vasodilatatory response is probably mediated by several mechanisms, with nitric oxide being one of the most important mediators. In the last years significant progress in measuring renal functional reserve has been achieved on the basis of improvements in methods for accurate and timely appropriate GFR measurement. The method of GFR measurement using the sinistrin clearence calculation after bolus injection of sinistrin is increasingly employed.
Conclusions. The article presents the latest results of experiments with RFR using this method and compares them with older reports. RFR is affected by several patophysiological processes: arterial hypertension, diabetes mellitus, deteriorating function of transplanted kidney. The results and impact of RFR determination in this conditions are described. Finally, potential for further research of RFR in atherosclerotic vascular disease is considered. Accurate determination of RFR is important for detection of early renal hemodynamic abnormalities, which can be influenced by therapeutic interventions and in this way the progression of renal functional deterioration could be prevented or at least slowed.
Downloads
References
Rolin H, Hall PM. Evaluation of glomerular filtration rate and renal plasma flow. In: Jacobson HR, Striker GE, Klahr S eds. The principles and practice of nephrology. 10th ed. Philadelphia: B.C. Decker Inc., 1991: 158–62.
Pullman TN, Alving AS, Deren RJ, Landowne M. The influence of dietary protein intake on specific renal functions in normal man. J Lab Clin Med 1954; 44: 322–32.
Bosch JP. Renal reserve: a functional view of glomerular filtration rate. Sem Nephrol 1995; 15: 381–5.
Zuccala A, Zucchelli P. Use and misuse of the renal functional reserve concept in clinical nephrology. Nephrol Dial Transplant 1990; 5: 410–7.
Zuccala A, Gaggi R, Zucchelli A et al. Renal functional reserve in patients with reduced number of functioning glomeruli. Clin Nephrol 1989; 32: 229–34.
De Santo NG, Capasso G, Anastasio P et al. The renal haemodynamic response following meat meal in children with chronic renal failure and in healthy controls. Nephron 1990; 56: 136–42.
Krishna GG, Kappor SC. Preservation of renal reserve in chronic renal disease. Am J Kidney Dis 1991; 17: 18–24.
Bosch JP, Lew SQ, Glabman S, Lauer A. Renal hemodynamic changes in humans: response to protein loading in normal and diseased kidneys. Am J Med 1986; 81: 809–15.
Woods LL. Intrarenal mechanisms of renal reserve. Sem Nephrol 1995; 15: 386–95.
King AJ. Nitric oxide and renal haemodynamic response to proteins. Sem Nephrol 1995; 15: 405–14.
Wilcox CS, Welch WJ, Murad F et al. Nitric oxide synthase in macula densa regulates glomerular capillary pressure. Proc Natl Acad SCI 1992; 89: 11993– 7.
Mundl P, Bachmann S, Bader M et al. Expression of nitric oxide synthase in kidney macula densa cells. Kidney Int 1992; 42: 1017–9.
Ito S, Ren YL. Evidence for the role of nitric oxide in macula densa control of glomerular haemodynamics. J Clin Invest 1993; 92: 1093–8.
King AJ, Troy JL, Anderson S et al. Nitric oxide: a potential mediator of aminoacid – induced renal hyperemia and hyperfiltration. J Am Soc Nephrol 1991; 1: 1271–7.
Gabbai FB, De Nicola L, Garcia GE, Blantz RC. Role of angiotensin in the regulation of renal response to proteins. Sem Nephrol 1995; 15: 396–404.
Ruilope LM, Rudicio J, Garcia Robles R et al. Influence of a low sodium diet on the renal response to amino acid infusions in humans. Kidney Int 1987; 31: 992–9.
Juncos L, Corneio JC, Pamies-Andrew E et al. Renal response to aminoacid infusion in essential hypertension. Hypertension 1994; 23: Suppl I: 225–30.
Magri P, Rao MA, Cangianello S, Bellizi W et al. Early imapirment of renal haemodynamic reserve in patients with asymptomatic heart failure is restored by angiotensin II antagonism. Circulation 1998; 98: 2849–54.
Hellerstein S, Berenbom M, Alon U, Warady BA. The renal clearance and infusion clearance of inulin are similar, but not identical. Kidney Intern 1993; 44: 1058–61.
Zitta S, Stoschitzky K, Zweiker R et al. Determination of renal reserve capacity by identification of kinetic systems. Math Comp Mod Dyn Sys 2000; 6: 190–207.
Estelberger W, Petek W, Zitta S et al. Determination of the glomerular filtration rate by identification of sinistrin kinetics. Eur J Clin Chem Clin Biochem 1995; 33: 201–9.
Estelberger W, Zitta S, Lang T et al. System identification of the low-dose kinetics of p-Aminohippuric acid. Eur J Clin Chem Clin Biochem 1995; 33: 847–53.
Zitta S et al. Dynamic renal function testing by compartmental analysis: assessment of renal functional reserve in essential hypertension. Nephrol Dial Transplant 2000; 15: 1162–9.
Losito A, Fortunati F, Zampi I, Del Favero A. Impaired renal functional reserve and albuminuria in essential hypertension. Br Med J 1988; 296: 1562–4.
Gabbai FB. Renal reserve in patients with high blood pressure. Sem Nephrol 1995; 15: 482–7.
O’Connor DT, Tyrell EA, Kailaasam MT et al. Early alteration in glomerular reserve in humans at genetic risk of essential hypertension. Hypertension 2001; 37: 898–906.
Grunfeld B, Perelstein E, Simsolo R, Gimenez M, Romero JC. Renal functional reserve and microalbuminuria in offspring of hypertensive patients. Hypertension 1990; 15: 257–61.
Gomez-Alamillo C, Sanchez-Casajus A, Sierra M, Huarte E, Diez J. Vasoconstriction of the afferent arteriole and defective renal synthesis of nitric oxide in essential hypertension. Kidney Int 1996; 49: S129–31.
Maggi E, Marchesi E, Covini D, Negro C, Perani G, Bellomo G. Protective effects of carvedilol, vasodilating beta-adrenoceptor blocker, against invivo low densitiy lipoprotein oxidation in essential hypertension. J Cardiovasc Pharmacol 1995; 4: 532–8.
Rizzoni D, Castellano M, Porteri E et al. Effects of low and high doses of fosinopril on the structure and function of resistance arteries. Hypertension 1995; 26: 118–23.
Greenberg A ed. Primer on kidney diseases. San Diego: National kidney foundation, 1994.
Jones SL, Viberti G. Renal functional reserve in subjects with diabetes mellitus. Sem Nephrol 1995; 15: 475–81.
Jones SL, Kontessis P, Wiseman M et al. Protein intake and blood glucose as modulators of GFR in hyperfiltrating diabetic patients. Kidney Int 1992; 41: 1620–8.
Wiseman MJ, Saunders AJ, Keen H, Viberti GC. Effect of blood glucose on increased glomerular filtration rate and kidney size in insulin-dependent diabetes mellitus. Kidney Int 1992; 41: 829–35.
Ter Wee PM, Tegzess AM, Donker AJM. Renal reserve filtration capacity before and after kidney donation. J Int Med 1990; 228: 393–9.
Rugiu C, Oldrizzi L, Maschio G. Renal reserve in patients with solitary kidneys. Sem Nephrol 1995; 15: 468–74.
Andersen S, Meyer TW, Rennke HG, Brenner BM. Control of glomerular hypertension limits glomerular injury in rats with reduced renal mass. J Clin Invest 1985; 76: 612–9.
Ader JL, Tack I, Durand D, Tran-Van T, Rostaing L, Suc JM. Renal functional reserve in kidney and heart transplant patients. J Am Soc Nephrol 1996; 7: 1145–52.
Englund M, Berg U. Renal response to a protein load persists during longterm follow-up of children after renal transplantation. Transplantation 2000; 70: 1342–7.
Pluvio C, DePascale E, Pluvio M et al. Renal hemodynamics in renal transplant recipients. The role of reduced kidney mass and Cyclosporine administration. Transplantation 1996; 61: 733–8.
Fagugli RM, Buoncristiani U, Selvi A et al. Reduction of renal functional reserve in kidney transplant recipients: a possible role of arachidonic acid metabolism alterations. Clin Nephrol 1998; 49: 349–55.
Zitta S, Holzer H, Reibnegger G, Estelberger W. Dynamic renal function testing in renal transplant recipients. Clin Nephrol 2000; 54: E15–5.
Zitta S, Holzer H, Lang T, Reibnegger G, Estelberger W. Dynamic renal function tests for the monitoring of renal transplant recipients (abstract). Ther Drug Monit 1997; 19: 601–1.
Wannamethe SG, Shaper AG, Perry IJ. Serum creatinine concentration and risk of cardiovascular disease: a possible marker for increased risk of stroke. Stroke 1997; 28: 557–63.
Matts JP, Kamegis JN, Campos CT, Fitch LL et al. Serum creatinine as an independent predictor of coronary heart disease mortality in normotensive survivors of miocardial infarction. POSCH group. J Fam Pract 1993; 36: 497– 503.
Schulman NB, Fort CE et al. Prognostic value of serum creatinine and effect of treatment of hypertension on renal function. Result from the hypertension detection and follow-up program. The hypertension detection and follow-up program cooperative group. Hypertension 1989; 13: Suppl I: 80– 93.
Freedman P. Serum creatinine: An independent predictor of survival after stroke. J Intern Med 1991; 229: 175–9.
Černe D, Kaplan-Pavlovčič S, Kranjc I, Jurgens G. Mildly elevated serum creatinine concentration correlates with the extent of coronary atherosclerosis. Renal Failure 2000; 6: 799–808.
Gale CR, Ashurst H, Fillips NJ, Moat SJ, Bouham JR, Martyn CN. Renal function, plasma homocysteine and carotid atherosclerosis in elderly people. Atherosclerosis 2001; 154: 141–6.
Shah AM. Vascular endothelium. BJ Hosp Med 1992; 48: 540–9.
Anderson TJ. Assessment and treatment of endothelial dysfunction in humans. J Am Coll Cardiol 1999; 34: 631–8.
Reddy KG, Nair RN, Sheehan HM, Hodgson JM. Evidence that selective endothelial dysfunction may occur in the absence of angiographic or ultrasound atherosclerosis in patients with risc factors for atherosclerosis. J Am Coll Cardiol 1994; 23: 833–43.
Anderson TJ, Gerhard MD, Meredith IT et al. Systemic nature of endothelial dysfunction in atherosclerosis. Am J Cardiol 1995; 75: Suppl: 71–4B.
Ross R. The patogenesis of atherosclerosis: a perspective for the 1990’s. Nature 1993; 362: 801–9.
Oemar BS, Tschudi MR, Godoy N, Brovkovich V et al. Reduced endothelial nitric synthase expression and production in human atherosclerosis. Circulation 1998; 97: 2494–8.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
