Original Investigations: Pathogenesis and Treatment of Kidney Disease and Hypertension
Dynamic renal blood flow measurement by positron emission tomography in patients with CRF*,**,

https://doi.org/10.1053/ajkd.2002.36325Get rights and content

Abstract

Background: Positron emission tomography (PET) is a functional imaging device that allows dynamic regional blood flow measurements. We performed a study to test whether PET could detect acute changes in renal blood flow (RBF) in patients with chronic renal failure (CRF). Methods: RBF was measured by means of PET (PET-RBF) using oxygen 15-labeled water (H215O) in eight men with hypertension and moderate CRF before and 5, 40, 80, and 120 minutes after the injection of quinaprilat (10 mg intravenously). Effective renal plasma flow (ERPF) and glomerular filtration rate (GFR) were measured simultaneously by para-aminohippuric acid (PAH-ERPF) and inulin clearances before and 20, 60, 100, and 140 minutes after quinaprilat injection. Results: Baseline RBF and ERPF were decreased in all patients (221 ± 20 mL/min/100 g and 225 ± 38 mL/min/1.73 m2, respectively). PET-RBF increased significantly after quinaprilat injection (+15%, +26%, +19%, and +23% versus baseline; P < 0.003). PAH-ERPF did not increase significantly (−6%, +12%, +20%, and +15% versus baseline; P = 0.15). GFR (50.1 ± 8.9 mL/min/1.73 m2 at baseline) did not change significantly after quinaprilat injection; however, filtration fraction (GFR-ERPF ratio) decreased significantly from 0.23% ± 0.02% to 0.20% ± 0.02% (P = 0.0004). Mean arterial pressure decreased significantly after quinaprilat injection (P < 0.005). Conclusion: This study dynamically measured RBF by means of PET in patients with CRF for the first time. It showed that RBF rapidly increased after quinaprilat injection. PET using H215O is a powerful method for the noninvasive measurement of dynamic changes in RBF that remain undetected by PAH clearance. Am J Kidney Dis 40:947-954. © 2002 by the National Kidney Foundation, Inc.

Section snippets

Procedure

PET measurements were performed before and 5, 40, 80, and 120 minutes after the injection of quinaprilat, 10 mg intravenously (active metabolite of quinapril; Parke Davis, Courbevoie, France). Inulin and PAH clearances were measured during two 30-minute periods for baseline value. Another 25-minute measurement was performed starting 5 minutes before quinaprilat injection and ending 20 minutes after the injection, followed by three 40-minute periods (20 to 60 minutes, 60 to 100 minutes, 100 to

PET-RBF

PET measurement was performed successfully in all patients. An example of PET images is shown in Fig 1.

. Renal PET static images using H215O. Each image represents a transversal slice in which high activity corresponds to the cortex (orange arrow on image 2) and higher activity to the aorta (red arrow on image 2). Orientation: Ant = up, Right = left. The upper left image represents the subdiaphragm slice, the lower right image, the inferior slice. Color scale shown on left side of the

Discussion

This study is the first report of the ability of PET to measure dynamically RBF in patients with CRF. It shows that a single intravenous injection of an ACE inhibitor induces a significant increase in PET-RBF. It shows that PET is a reliable method for measuring RBF in humans and may be more sensitive than PAH clearance for detecting acute RBF changes in humans.

In this study, PET and PAH clearances both measured low RBF, as expected in patients with CRF. Normal cortical blood flow is estimated

Acknowledgements

The authors thank D. Comar and J.F. Pujol, CERMEP Directors; Gérard Galy, Véronique Berthier, Franck Lavenne, Christian Pierre, Dorothée Parisot, Christine Vighi, Martine Lionnet, Marie Christine Lamure, Laurent Veyre, and Fréderic Bonnefoi for pertinent advice and technical assistance; Dr Varennes (Laboratoire de Biochimie, Hôpital Edouard Herriot) for measuring ACE activity in this study; and Carlos Romero, Lilach Lerman, Luis Juncos (Physiology and Biophysics, Mayo Clinic, Rochester, MN) and

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*

Supported in part by Parke Davis, France.

**

Address reprint requests to Laurent Juillard, MD, PhD, Hôpital Edouard Herriot, Pavillon P, 3 place D'Arsonval, 69437 Lyon Cedex 03, France. E-mail: [email protected]

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