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Renal Blood Flow

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Abstract

The sections in this article are:

1 Measurement of Renal Blood Flow
1.1 Total Renal Blood Flow
1.2 Regional Cortical Blood Flow
1.3 Medullary Blood Flow
1.4 Renal Microcirculation
2 Control of Renal Circulation
2.1 Intrinsic Factors
2.2 Extrinsic Control
3 Renovascular Resistance Changes in Selected Pathophysiological States
3.1 Extracellular Volume Expansion
3.2 Hemorrhagic Hypotension
3.3 Acute Renal Failure
Figure 1. Figure 1.

Typical 85Kr disappearance curve (heavy black line) following injection of isotope into renal artery, with resultant exponentials (thin lines). Inset presents pertinent data and derived values obtained from such a curve.

From Thorburn et al.
Figure 2. Figure 2.

Comparison of fractional distribution of blood flow in same area of cortex after injection of two different radioactive microspheres. Corresponding cortical zone for each point is given.

From Stein et al.
Figure 3. Figure 3.

Schematic of renal dimensions and zones into which kidney tissue was divided in preparation for radioactivity measurements (not to scale). Four cortex zones (C1 to C4) were of equal thickness. C4 included some outer medullary (OM) tissue because of scalloped margin between cortex and medulla. IM, inner medulla.

From McNay and Abe
Figure 4. Figure 4.

A: schematic cross section of dog kidney, showing arterial blood supply. B: part of interlobular artery with branching afferent arteriole (aa).

From Øfjord and Clausen
Figure 5. Figure 5.

Comparison of simultaneous microsphere and contrast medium distribution in dog kidney. Line was drawn through zero intercept and point for midcortex as source for reference only. Dynamic spatial reconstructor and radioactive microsphere data describe exteriorized left kidney: 5 mm thick sagittal sections were observed with scan aperture of 0.06 s. The 19 kg dog was sodium replete. It was administered a single 2 cc injection of Renovist over 4 s.

From Knox et al. , Kidney Int., with permission
Figure 6. Figure 6.

Renal autoregulatory curve of total renal blood flow measured from flowmeter (○) and with laser Doppler spectroscopy (Δ).

From Stern et al.
Figure 7. Figure 7.

Renal autoregulatory curve of papillary blood flow measured by laser Doppler spectroscopy.

From Stern et al.
Figure 8. Figure 8.

Regional intrarenal perfusion in dog: comparison of results obtained with multiple methods. Intravascular transit studies involve local measurement of transit of intravascular indicator, including Evans blue dye–tagged plasma proteins

performed by Kramer et al. ], 32P‐tagged red blood cells [Wolgast ], and radioiodinated serum albumin [Lilienfield et al. ]. Measurements made with delivery‐limited techniques involve indicators such as rubidium [Rb, Steiner and King ] or tagged microspheres [MI, McNay and Abe , Slotkoff et al. ] that are trapped in kidney so that amount in tissue reflects amount delivered, or blood flow. Washout studies are performed with highly diffusible radioactive tracers krypton [Kr, Thorburn et al. ] and xenon [Xe, Slotkoff et al. , Hollenberg et al. ] and external counting. [From Hollenberg et al.
Figure 9. Figure 9.

Schematic of technique for in vitro isolated glomerular perfusion.

From Osgood et al.
Figure 10. Figure 10.

Schematic drawing of cannulated vessel. A, holding pipette; B, perfusion pipette; C, fluid exchange tube; D, collecting pipette. Vessel lumen is occluded by constriction in collecting pipette.

From Duling et al.
Figure 11. Figure 11.

Schematic of transverse section of rat kidney. Major anatomical areas are indicated in capital letters. CC, cortex corticis; C, cortex; OS, outer stripe of outer medulla; IS, inner stripe of outer medulla; IM, inner medulla; PAP, papilla; arv, transversal section of arcuate vessels (artery and vein); caps, renal capsule; ocs, outside cortical surface; ics, inside cortical surface normally covered by pelvic mucosa (pm); mrb, margin of renal hilus. Black dots represent outermost glomerular layer. It is covered by cortex corticis at outside cortical surface. Glomeruli become superficial at inside cortical surface. Pelvic cavity indicated in black.

From Casellas and Navar
Figure 12. Figure 12.

Pressure gradients in renal circulation.

From Stein, J. H. Renal circulation. In: Physiology of the Kidney and Body Fluids (3rd ed.), edited by R. F. Pitts. Chicago: Year Book, 1974, reproduced with permission
Figure 13. Figure 13.

Correlation of absolute values for single nephron afferent (AR) and efferent (ER) arteriolar vascular resistances as evaluated by micropuncture in several physiological conditions in Munich‐Wistar rat. Symbols designate different conditions, including hydropenia, volume‐expanded states, infusion of angiotensin II, increased ureteral pressure, and so forth, for a large range of values of nephron filtration rate and nephron blood flow. Across this wide range of values for single nephron vascular resistances there is significant tendency for AR and ER to change in parallel. Specific mechanism or mechanisms that link changes in AR to changes in ER have not been elucidated completely.

From Blantz , reproduced with permission, from the Annual Review of Physiology, Volume 42, © 1980 by the Annual Reviews Inc
Figure 14. Figure 14.

Representative responses in total renal resistance (TRR), intrarenal resistance (IRR), and preglomerular resistance (AR) to changes in arterial pressure. Area between TRR and IRR represents venous resistance (VR) and shaded area between IRR and AR represents efferent resistance (ER).

From Navar
Figure 15. Figure 15.

Pressure‐diameter characteristics of renal microvessels. Intraluminal pressure was increased in increments of 10 mm Hg, and lumen diameter was measured at each pressure. Each point represents mean ± S.E. Numbers in parentheses indicate numbers of vessels studied.

From Edwards
Figure 16. Figure 16.

Schematic of localization of components of renin‐angiotensin system within renal vasculature (membrane bound or intracellular) based on immunohistochemical and autoradiographic studies in 1980. JGC, juxtaglomerular cell.

From Navar and Rosivall , Kidney Int., with permission
Figure 17. Figure 17.

Average change in arterial pressure seen with injection of arginine vassopressin inhibitor dPVDAVP after arterial pressure had compensated following hemorrhage. Arterial pressure fell to its precompensated state of 50 mm Hg within 1 min after injection in four dogs.

From Cowley et al.
Figure 18. Figure 18.

Original tracing of renal blood flow (RBF) and arterial blood pressure (BP) in dog during control, adenosine, and recovery periods. Kidney glomerular filtration rate (K‐GFR) and superficial nephron glomerular filtration rates (SNGFR) during experimental periods are given at bottom.

From Osswald et al.
Figure 19. Figure 19.

Effects of intrarenal adenosine infusion (2 μg·kg−1 · min−1) on arterial pressure and renal hemodynamics in six control uninephrectomized normal dogs. Values are means ± S.E. C, control.

From Hall and Granger
Figure 20. Figure 20.

Relaxation of afferent (top) and efferent (bottom) arterioles to acetylcholine (ACh), dopamine (DA), bradykinin (BK), adenosine (ADO), and prostaglandins (PG). Tone was induced with 3 × 10 7 M norepinephrine. Numbers in parentheses are numbers of arterioles. Standard errors omitted for clarity.

From Navar et al.
Figure 21. Figure 21.

Hemodynamic parameters for group in which renal perfusion pressure was maintained at constant level throughout control and atrial natriuretic peptide (ANP) infusion periods. Values are means ± S.E.M; *P < 0.05 versus control period by paired t test. SNGFR, single nephron glomerular filtration rate; SNFF, single nephron filtration fraction; RA, afferent arteriolar resistance; RE, efferent arteriolar resistance; QA, afferent flow rate; , arterial pressure; , glomerular capillary pressure.

From Dunn et al.


Figure 1.

Typical 85Kr disappearance curve (heavy black line) following injection of isotope into renal artery, with resultant exponentials (thin lines). Inset presents pertinent data and derived values obtained from such a curve.

From Thorburn et al.


Figure 2.

Comparison of fractional distribution of blood flow in same area of cortex after injection of two different radioactive microspheres. Corresponding cortical zone for each point is given.

From Stein et al.


Figure 3.

Schematic of renal dimensions and zones into which kidney tissue was divided in preparation for radioactivity measurements (not to scale). Four cortex zones (C1 to C4) were of equal thickness. C4 included some outer medullary (OM) tissue because of scalloped margin between cortex and medulla. IM, inner medulla.

From McNay and Abe


Figure 4.

A: schematic cross section of dog kidney, showing arterial blood supply. B: part of interlobular artery with branching afferent arteriole (aa).

From Øfjord and Clausen


Figure 5.

Comparison of simultaneous microsphere and contrast medium distribution in dog kidney. Line was drawn through zero intercept and point for midcortex as source for reference only. Dynamic spatial reconstructor and radioactive microsphere data describe exteriorized left kidney: 5 mm thick sagittal sections were observed with scan aperture of 0.06 s. The 19 kg dog was sodium replete. It was administered a single 2 cc injection of Renovist over 4 s.

From Knox et al. , Kidney Int., with permission


Figure 6.

Renal autoregulatory curve of total renal blood flow measured from flowmeter (○) and with laser Doppler spectroscopy (Δ).

From Stern et al.


Figure 7.

Renal autoregulatory curve of papillary blood flow measured by laser Doppler spectroscopy.

From Stern et al.


Figure 8.

Regional intrarenal perfusion in dog: comparison of results obtained with multiple methods. Intravascular transit studies involve local measurement of transit of intravascular indicator, including Evans blue dye–tagged plasma proteins

performed by Kramer et al. ], 32P‐tagged red blood cells [Wolgast ], and radioiodinated serum albumin [Lilienfield et al. ]. Measurements made with delivery‐limited techniques involve indicators such as rubidium [Rb, Steiner and King ] or tagged microspheres [MI, McNay and Abe , Slotkoff et al. ] that are trapped in kidney so that amount in tissue reflects amount delivered, or blood flow. Washout studies are performed with highly diffusible radioactive tracers krypton [Kr, Thorburn et al. ] and xenon [Xe, Slotkoff et al. , Hollenberg et al. ] and external counting. [From Hollenberg et al.


Figure 9.

Schematic of technique for in vitro isolated glomerular perfusion.

From Osgood et al.


Figure 10.

Schematic drawing of cannulated vessel. A, holding pipette; B, perfusion pipette; C, fluid exchange tube; D, collecting pipette. Vessel lumen is occluded by constriction in collecting pipette.

From Duling et al.


Figure 11.

Schematic of transverse section of rat kidney. Major anatomical areas are indicated in capital letters. CC, cortex corticis; C, cortex; OS, outer stripe of outer medulla; IS, inner stripe of outer medulla; IM, inner medulla; PAP, papilla; arv, transversal section of arcuate vessels (artery and vein); caps, renal capsule; ocs, outside cortical surface; ics, inside cortical surface normally covered by pelvic mucosa (pm); mrb, margin of renal hilus. Black dots represent outermost glomerular layer. It is covered by cortex corticis at outside cortical surface. Glomeruli become superficial at inside cortical surface. Pelvic cavity indicated in black.

From Casellas and Navar


Figure 12.

Pressure gradients in renal circulation.

From Stein, J. H. Renal circulation. In: Physiology of the Kidney and Body Fluids (3rd ed.), edited by R. F. Pitts. Chicago: Year Book, 1974, reproduced with permission


Figure 13.

Correlation of absolute values for single nephron afferent (AR) and efferent (ER) arteriolar vascular resistances as evaluated by micropuncture in several physiological conditions in Munich‐Wistar rat. Symbols designate different conditions, including hydropenia, volume‐expanded states, infusion of angiotensin II, increased ureteral pressure, and so forth, for a large range of values of nephron filtration rate and nephron blood flow. Across this wide range of values for single nephron vascular resistances there is significant tendency for AR and ER to change in parallel. Specific mechanism or mechanisms that link changes in AR to changes in ER have not been elucidated completely.

From Blantz , reproduced with permission, from the Annual Review of Physiology, Volume 42, © 1980 by the Annual Reviews Inc


Figure 14.

Representative responses in total renal resistance (TRR), intrarenal resistance (IRR), and preglomerular resistance (AR) to changes in arterial pressure. Area between TRR and IRR represents venous resistance (VR) and shaded area between IRR and AR represents efferent resistance (ER).

From Navar


Figure 15.

Pressure‐diameter characteristics of renal microvessels. Intraluminal pressure was increased in increments of 10 mm Hg, and lumen diameter was measured at each pressure. Each point represents mean ± S.E. Numbers in parentheses indicate numbers of vessels studied.

From Edwards


Figure 16.

Schematic of localization of components of renin‐angiotensin system within renal vasculature (membrane bound or intracellular) based on immunohistochemical and autoradiographic studies in 1980. JGC, juxtaglomerular cell.

From Navar and Rosivall , Kidney Int., with permission


Figure 17.

Average change in arterial pressure seen with injection of arginine vassopressin inhibitor dPVDAVP after arterial pressure had compensated following hemorrhage. Arterial pressure fell to its precompensated state of 50 mm Hg within 1 min after injection in four dogs.

From Cowley et al.


Figure 18.

Original tracing of renal blood flow (RBF) and arterial blood pressure (BP) in dog during control, adenosine, and recovery periods. Kidney glomerular filtration rate (K‐GFR) and superficial nephron glomerular filtration rates (SNGFR) during experimental periods are given at bottom.

From Osswald et al.


Figure 19.

Effects of intrarenal adenosine infusion (2 μg·kg−1 · min−1) on arterial pressure and renal hemodynamics in six control uninephrectomized normal dogs. Values are means ± S.E. C, control.

From Hall and Granger


Figure 20.

Relaxation of afferent (top) and efferent (bottom) arterioles to acetylcholine (ACh), dopamine (DA), bradykinin (BK), adenosine (ADO), and prostaglandins (PG). Tone was induced with 3 × 10 7 M norepinephrine. Numbers in parentheses are numbers of arterioles. Standard errors omitted for clarity.

From Navar et al.


Figure 21.

Hemodynamic parameters for group in which renal perfusion pressure was maintained at constant level throughout control and atrial natriuretic peptide (ANP) infusion periods. Values are means ± S.E.M; *P < 0.05 versus control period by paired t test. SNGFR, single nephron glomerular filtration rate; SNFF, single nephron filtration fraction; RA, afferent arteriolar resistance; RE, efferent arteriolar resistance; QA, afferent flow rate; , arterial pressure; , glomerular capillary pressure.

From Dunn et al.
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Claudia Hura, Jay H. Stein. Renal Blood Flow. Compr Physiol 2011, Supplement 25: Handbook of Physiology, Renal Physiology: 1129-1184. First published in print 1992. doi: 10.1002/cphy.cp080125