Dynamic myogenic autoregulation in the rat kidney: a whole-organ model

Toward a full-scale model of renal hemodynamics using a reconstructed vascular tree

The kidney's vascular network stands out because 1) the microcirculation not only supplies the tissues with oxygen and nutrients but also supports glomerular filtration in each nephron, 2) it contains the tubuloglomerular feedback, a mechanism that contributes to renal blood flow autoregulation and is unique to the kidney, and 3) the topology of the renal arterial network influences signaling along the vessels mediating nephron-nephron interactions. We have developed a full-scale vascular model of the rat kidney based on a reconstructed vascular network combined with a nephron model that includes glomerular filtration, tubular reabsorption, and autoregulation of afferent arteriolar resistances. The model evaluates the steady-state operating conditions of approximately 30,000 nephrons in a rat kidney and the efficiency of autoregulation under normal and pathological conditions. The simulation results show how the regulated afferent arteriolar resistances stabilize blood flow in the reconstructed full-scale renal vascular network. It is concluded that by using a reconstructed renal vascular tree, it is possible to develop a realistic full-scale model of the regulation of renal hemodynamics as a first step toward creating a virtual kidney.NEW & NOTEWORTHY We have developed the first full-scale steady-state model integrating a realistic vascular network topology of the kidney and its hemodynamic regulatory mechanisms. The vascular network is combined with approximately 30,000 nephron models that include glomerular filtration, tubular reabsorption, and autoregulation of the afferent arteriolar resistances. By simulating the adaptive properties of the renal microcirculation at steady state, our approach demonstrates the feasibility of utilizing a reconstructed vascular network for comprehensive modeling of renal function.

Numerical simulation of the vascular structure dependence of blood flow in the kidney

A numerical simulation was performed to clarify renal blood flow determination by the vascular structures. Large and small vessels were modeled as symmetric and asymmetric branching vessels, respectively, with simple geometries to parameterize the vascular structures. Modeling individual vessels as straight pipes, Murray's law was used to determine the vessel diameters. Blood flow in the vascular structure was calculated by network analysis based on Hagen-Poiseuille's law. Blood flow simulations for a vascular network segment demonstrated that blood flow rate and pressure vary within the same-generation vessels because of an asymmetric vessel branch while they generally tend to decrease with vessel diameter; thus, the standard deviation of flow rate relative to the mean (relative standard deviation [RSD]) increased from 0.4 to 1.0 when the number of the daughter vessels increased from 3 to 10. Blood flow simulations for an entire vascular network of a kidney showed that the vessel number and branching style, rather than Strahler order, are major parameters in successfully reproducing renal blood flow measured in published experiments. The entire vascular network could generate variation in the physiological flow rate in afferent arterioles at 0.2-0.38 in RSD, which is at least compatible with 0.16 by diameter variation within the same-generation vessels.

Numerical Modeling and Simulation of Blood Flow in a Rat Kidney: Coupling of the Myogenic Response and the Vascular Structure

A numerical simulation was carried out to investigate the blood flow behavior (i.e., flow rate and pressure) and coupling of a renal vascular network and the myogenic response to various conditions. A vascular segment and an entire kidney vascular network were modeled by assuming one single vessel as a straight pipe whose diameter was determined by Murray’s law. The myogenic response was tested on individual AA (afferent artery)–GC (glomerular capillaries)–EA (efferent artery) systems, thereby regulating blood flow throughout the vascular network. Blood flow in the vascular structure was calculated by network analysis based on Hagen–Poiseuille’s law to various boundary conditions. Simulation results demonstrated that, in the vascular segment, the inlet pressure Pinlet and the vascular structure act together on the myogenic response of each individual AA–GC–EA subsystem, such that the early-branching subsystems in the vascular network reached the well-regulated state first, with an interval of the inlet as Pinlet = 10.5–21.0 kPa, whereas the one that branched last exhibited a later interval with Pinlet = 13.0–24.0 kPa. In the entire vascular network, in contrast to the Pinlet interval (13.0–20.0 kPa) of the unified well-regulated state for all AA–GC–EA subsystems of the symmetric model, the asymmetric model exhibited the differences among subsystems with Pinlet ranging from 12.0–17.0 to 16.0–20.0 kPa, eventually achieving a well-regulated state of 13.0–18.5 kPa for the entire kidney. Furthermore, when Pinlet continued to rise (e.g., 21.0 kPa) beyond the vasoconstriction range of the myogenic response, high glomerular pressure was also related to vascular structure, where PGC of early-branching subsystems was 9.0 kPa and of late-branching one was 7.5 kPa. These findings demonstrate how the myogenic response regulates renal blood flow in vascular network system that comprises a large number of vessel elements.

Determining risk factors for triple whammy acute kidney injury

Concurrent use of a diuretic, a renin-angiotensin system (RAS) inhibitor, and a non-steroidal anti-inflammatory drug (NSAID) significantly increases the risk of acute kidney injury (AKI). This phenomenon is known as "triple whammy". Diuretics and RAS inhibitors, such as an angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker, are often prescribed in tandem for the treatment of hypertension, whereas some NSAIDs, such as ibuprofen, are available over the counter. As such, concurrent treatment with all three drugs is common. The goals of this study are to better understand the mechanisms underlying the development of triple whammy AKI and to identify physiological factors that may increase an individual's susceptibility. To accomplish these goals, we utilize sex-specific computational models of long-term blood pressure regulation. These models include variables describing the heart and circulation, kidney function, sodium and water reabsorption in the nephron and the RAS and are parameterized separately for men and women. Hypertension is modeled as overactive renal sympathetic nervous activity. Model simulations suggest that low water intake, the myogenic response, and drug sensitivity may predispose patients with hypertension to develop triple whammy-induced AKI. Triple treatment involving an ACE inhibitor, furosemide, and NSAID results in blood pressure levels similar to double treatment with ACEI and furosemide. Additionally, the male and female hypertensive models act similarly in most situations, except for the ACE inhibitor and NSAID double treatment.

Epidemiology and Pathogenesis of Acute Kidney Injury in the Critically Ill Patients

How to cite this article: Kulkarni AP, Bhosale SJ. Epidemiology and Pathogenesis of Acute Kidney Injury in the Critically Ill Patients. Indian J Crit Care Med 2020;24(Suppl 3):S84–S89.

A Multicellular Vascular Model of the Renal Myogenic Response

The myogenic response is a key autoregulatory mechanism in the mammalian kidney. Triggered by blood pressure perturbations, it is well established that the myogenic response is initiated in the renal afferent arteriole and mediated by alterations in muscle tone and vascular diameter that counterbalance hemodynamic perturbations. The entire process involves several subcellular, cellular, and vascular mechanisms whose interactions remain poorly understood. Here, we model and investigate the myogenic response of a multicellular segment of an afferent arteriole. Extending existing work, we focus on providing an accurate—but still computationally tractable—representation of the coupling among the involved levels. For individual muscle cells, we include detailed Ca2+ signaling, transmembrane transport of ions, kinetics of myosin light chain phosphorylation, and contraction mechanics. Intercellular interactions are mediated by gap junctions between muscle or endothelial cells. Additional interactions are mediated by hemodynamics. Simulations of time-independent pressure changes reveal regular vasoresponses throughout the model segment and stabilization of a physiological range of blood pressures (80–180 mmHg) in agreement with other modeling and experimental studies that assess steady autoregulation. Simulations of time-dependent perturbations reveal irregular vasoresponses and complex dynamics that may contribute to the complexity of dynamic autoregulation observed in vivo. The ability of the developed model to represent the myogenic response in a multiscale and realistic fashion, under feasible computational load, suggests that it can be incorporated as a key component into larger models of integrated renal hemodynamic regulation.

A dynamic computational network model for the role of nitric oxide and the myogenic response in microvascular flow regulation

OBJECTIVES

The effect of NO on smooth muscle cell contractility is crucial in regulating vascular tone, blood flow, and O₂ delivery. Quantitative predictions for interactions between the NO production rate and the myogenic response for microcirculatory blood vessels are lacking.

METHODS

We developed a computational model of a branching microcirculatory network with four representative classes of resistance vessels to predict the effect of endothelium-derived NO on the microvascular pressure-flow response. Our model links vessel scale biotransport simulations of NO and O₂ delivery to a mechanistic model of autoregulation and myogenic tone in a simplified microcirculatory network.

RESULTS

The model predicts that smooth muscle cell NO bioavailability significantly contributes to resting vascular tone of resistance vessels. Deficiencies in NO seen during hypoxia or ischemia lead to a decreased vessel diameter for all classes at a given intravascular pressure. At the network level, NO deficiencies lead to an increase in pressure drop across the vessels studied, a downward shift in the pressure-flow curve, and a decrease in the effective range of the autoregulatory response.

CONCLUSIONS

Our model predicts the steady state and transient behavior of resistance vessels to perturbations in blood pressure, including effects of NO bioavailability on vascular regulation.

Three-dimensional morphometric analysis of the renal vasculature

Vascular topology and morphology are critical in the regulation of blood flow and the transport of small solutes, including oxygen, carbon dioxide, nitric oxide, and hydrogen sulfide. Renal vascular morphology is particularly challenging, since many arterial walls are partially wrapped by the walls of veins. In the absence of a precise characterization of three-dimensional branching vascular geometry, accurate computational modeling of the intrarenal transport of small diffusible molecules is impossible. An enormous manual effort was required to achieve a relatively precise characterization of rat renal vascular geometry, highlighting the need for an automated method for analysis of branched vasculature morphology to allow characterization of the renal vascular geometry of other species, including humans. We present a semisupervised method for three-dimensional morphometric analysis of renal vasculature images generated by computed tomography. We derive quantitative vascular attributes important to mass transport between arteries, veins, and the renal tissue and present methods for their computation for a three-dimensional vascular geometry. To validate the algorithm, we compare automated vascular estimates with subjective manual measurements for a portion of rabbit kidney. Although increased image resolution can improve outcomes, our results demonstrate that the method can quantify the morphological characteristics of artery-vein pairs, comparing favorably with manual measurements. Similar to the rat, we show that rabbit artery-vein pairs become less intimate along the course of the renal vasculature, but the total wrapped mass transfer coefficient increases and then decreases. This new method will facilitate new quantitative physiological models describing the transport of small molecules within the kidney.

Practical approach to detection and management of acute kidney injury in critically ill patient

Background

Acute kidney injury (AKI) is a common complication in critically ill patients and is associated with high morbidity and mortality. This paper provides a critical review of the etiologies of AKI and a systematic approach toward its diagnosis and management with emphasis on fluid volume assessment and the use of urine biochemical profile and microscopy in identifying the nature and the site of kidney injury.

Materials and methods

The search of PubMed and selection of papers had employed observational designs or randomized control trials relevant to AKI.

Results

AKI is defined by the rate of rise of serum creatinine and a decline in urine output. The pathophysiology is diverse and requires a careful and systematic assessment of predisposing factors and localization of site of injury. The majority of AKIs are due to prerenal causes such as fluid volume deficit, sepsis, or renal as in acute tubular injury. The use of central venous and arterial blood pressure monitoring and inferior vena cava echocardiography complemented by urine analysis and microscopy allows assessment of fluid volume status and AKI etiology.

Conclusions

Timely intervention by avoidance of fluid volume deficit and nephrotoxic agents and blood pressure support can reduce the incidence of AKI in critically ill patients.

Mechanisms of triple whammy acute kidney injury

Pre-renal acute kidney injury (AKI) results from glomerular haemodynamic alterations leading to reduced glomerular filtration rate (GFR) with no parenchymal compromise. Renin-angiotensin system inhibitors, such as angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor antagonists (ARAs), non-steroidal anti-inflammatory drugs (NSAIDs) and diuretics, are highly prescribed drugs that are frequently administered together. Double and triple associations have been correlated with increased pre-renal AKI incidence, termed "double whammy" and "triple whammy", respectively. This article presents an integrative analysis of the complex interplay among the effects of NSAIDs, ACEIs/ARAs and diuretics, acting alone and together in double and triple therapies. In addition, we explore how these drug combinations alter the equilibrium of regulatory mechanisms controlling blood pressure (renal perfusion pressure) and GFR to increase the odds of inducing AKI through the concomitant reduction of blood pressure and distortion of renal autoregulation. Using this knowledge, we propose a more general model of pre-renal AKI based on a multi whammy model, whereby several factors are necessary to effectively reduce net filtration. The triple whammy was the only model associated with pre-renal AKI accompanied by a course of other risk factors, among numerous potential combinations of clinical circumstances causing hypoperfusion in which renal autoregulation is not operative or is deregulated. These factors would uncouple the normal BP-GFR relationship, where lower GFR values are obtained at every BP value.

Transfer Function Analysis of Dynamic Blood Flow Control in the Rat Kidney

Renal blood flow is regulated by the myogenic response (MR) and tubuloglomerular feedback (TGF). Both mechanisms function to buffer not only steady pressure perturbations but also transient ones. In this study, we develop two models of renal autoregulation-a comprehensive model and a simplified model-and use them to analyze the individual contributions of MR and TGF in buffering transient pressure perturbations. Both models represent a single nephron of a rat kidney together with the associated vasculature. The comprehensive model includes detailed representation of the vascular properties and cellular processes. In contrast, the simplified model represents a minimal set of key processes. To assess the degree to which fluctuations in renal perfusion pressure at different frequencies are attenuated, we derive a transfer function for each model. The transfer functions of both models predict resonance at 45 and 180 mHz, which are associated with TGF and MR, respectively, effective autoregulation below [Formula: see text]100 mHz, and amplification of pressure perturbations above [Formula: see text]200 mHz. The predictions are in good agreement with experimental findings.

Renal autoregulation in health and disease

Intrarenal autoregulatory mechanisms maintain renal blood flow (RBF) and glomerular filtration rate (GFR) independent of renal perfusion pressure (RPP) over a defined range (80-180 mmHg). Such autoregulation is mediated largely by the myogenic and the macula densa-tubuloglomerular feedback (MD-TGF) responses that regulate preglomerular vasomotor tone primarily of the afferent arteriole. Differences in response times allow separation of these mechanisms in the time and frequency domains. Mechanotransduction initiating the myogenic response requires a sensing mechanism activated by stretch of vascular smooth muscle cells (VSMCs) and coupled to intracellular signaling pathways eliciting plasma membrane depolarization and a rise in cytosolic free calcium concentration ([Ca(2+)]i). Proposed mechanosensors include epithelial sodium channels (ENaC), integrins, and/or transient receptor potential (TRP) channels. Increased [Ca(2+)]i occurs predominantly by Ca(2+) influx through L-type voltage-operated Ca(2+) channels (VOCC). Increased [Ca(2+)]i activates inositol trisphosphate receptors (IP3R) and ryanodine receptors (RyR) to mobilize Ca(2+) from sarcoplasmic reticular stores. Myogenic vasoconstriction is sustained by increased Ca(2+) sensitivity, mediated by protein kinase C and Rho/Rho-kinase that favors a positive balance between myosin light-chain kinase and phosphatase. Increased RPP activates MD-TGF by transducing a signal of epithelial MD salt reabsorption to adjust afferent arteriolar vasoconstriction. A combination of vascular and tubular mechanisms, novel to the kidney, provides for high autoregulatory efficiency that maintains RBF and GFR, stabilizes sodium excretion, and buffers transmission of RPP to sensitive glomerular capillaries, thereby protecting against hypertensive barotrauma. A unique aspect of the myogenic response in the renal vasculature is modulation of its strength and speed by the MD-TGF and by a connecting tubule glomerular feedback (CT-GF) mechanism. Reactive oxygen species and nitric oxide are modulators of myogenic and MD-TGF mechanisms. Attenuated renal autoregulation contributes to renal damage in many, but not all, models of renal, diabetic, and hypertensive diseases. This review provides a summary of our current knowledge regarding underlying mechanisms enabling renal autoregulation in health and disease and methods used for its study.

Hormonal regulation of salt and water excretion: a mathematical model of whole kidney function and pressure natriuresis

We present a lumped-nephron model that explicitly represents the main features of the underlying physiology, incorporating the major hormonal regulatory effects on both tubular and vascular function, and that accurately simulates hormonal regulation of renal salt and water excretion. This is the first model to explicitly couple glomerulovascular and medullary dynamics, and it is much more detailed in structure than existing whole organ models and renal portions of multiorgan models. In contrast to previous medullary models, which have only considered the antidiuretic state, our model is able to regulate water and sodium excretion over a variety of experimental conditions in good agreement with data from experimental studies of the rat. Since the properties of the vasculature and epithelia are explicitly represented, they can be altered to simulate pathophysiological conditions and pharmacological interventions. The model serves as an appropriate starting point for simulations of physiological, pathophysiological, and pharmacological renal conditions and for exploring the relationship between the extrarenal environment and renal excretory function in physiological and pathophysiological contexts.

Capillary recruitment in a theoretical model for blood flow regulation in heterogeneous microvessel networks

In striated muscle, the number of capillaries containing moving red blood cells increases with increasing metabolic demand. This phenomenon, termed capillary recruitment, has long been recognized, but its mechanism has been unclear. Here, a theoretical model for metabolic blood flow regulation in a heterogeneous network is used to test the hypothesis that capillary recruitment occurs as a result of active control of arteriolar diameters, combined with unequal partition of hematocrit at diverging microvascular bifurcations. The network structure is derived from published observations of hamster cremaster muscle in control and dilated states. The model for modulation of arteriolar diameters includes length-tension characteristics of vascular smooth muscle and responses of smooth muscle tone to myogenic, shear-dependent, and metabolic stimuli. Blood flow is simulated including nonuniform hematocrit distribution. Convective and diffusive oxygen transport in the network is simulated. Oxygen-dependent metabolic signals are assumed to be conducted upstream from distal vessels to arterioles. With increasing oxygen demand, arterioles dilate, blood flow increases, and the numbers of flowing arterioles and capillaries, as defined by red blood cell flux above a small threshold value, increase. Unequal hematocrit partition at diverging bifurcations contributes to recruitment and enhances tissue oxygenation. The results imply that capillary recruitment, as observed in the hamster cremaster preparations, can occur as a consequence of local control of arteriolar tone and the resulting nonuniform changes in red blood cell fluxes, and provide an explanation for observations of sequential recruitment of individual capillaries in response to modulation of terminal arteriolar diameter.

Autoregulation and mechanotransduction control the arteriolar response to small changes in hematocrit

Here, we present an analytic model of arteriolar mechanics that accounts for key autoregulation mechanisms, including the myogenic response and the vasodilatory effects of nitric oxide (NO) in the vasculature. It couples the fluid mechanics of blood flow in arterioles with solid mechanics of the vessel wall and includes the effects of wall shear stress- and stretch-induced endothelial NO production. The model can be used to describe the regulation of blood flow and NO transport under small changes in hematocrit and to analyze the regulatory response of arterioles to small changes in hematocrit. Our analysis revealed that the experimentally observed paradoxical increase in cardiac output with small increases in hematocrit results from the combination of increased NO production and the effects of a strong myogenic response modulated by elevated levels of WSS. Our findings support the hypothesis that vascular resistance varies inversely with blood viscosity for small changes in hematocrit in a healthy circulation that responds to shear stress stimuli. They also suggest beneficial effects independent of changes in O(2) carrying capacity associated with the postsurgical transfusion of one or two units of blood.

Hyperglycaemia emerging during general anaesthesia induces rat acute kidney injury via impaired microcirculation, augmented apoptosis and inhibited cell proliferation

AIM

Major surgery under general anaesthesia frequently triggers acute kidney injury by yet unknown mechanisms. We investigated the role of anaesthesia-triggered systemic hyperglycaemia in impairment of renal functioning, renal tissue injury, intra-renal Angiotensin-II synthesis and endogenous insulin production in anaesthetized rats.

METHODS

Eighty-eight Sprague-Dawley rats underwent general anaesthesia for 1 h by different anaesthetic compounds. Some of the animals were either injected with high glucose, or received insulin prior to anaesthesia. Blood pressure, renal functioning estimated by cystatin-C and urea, renal perfusion evaluated by laser Doppler technique, blood glucose and insulin were surveyed. Subsequently, rat kidneys were excised, to be used for immunohistochemical examinations or preparation of renal extracts for intra-renal Angiotensin-II measurements.

RESULTS

Elevated blood sugar was observed 5 min following induction of anaesthesia, concurrently with deterioration of renal functioning, drop of systemic blood pressure and decreased renal blood flow. Blood insulin concentrations positively correlated with glucose levels. Intra-renal Angiotensin-II was significantly augmented. Immunohistochemical examinations demonstrated enhanced staining for pro-apoptotic proteins and negligible cell proliferation in tubular tissues. Renal damage resultant from anaesthesia-induced hyperglycaemia could be attenuated by insulin injections. Rats challenged with glucose prior to anaesthesia demonstrated cumulative hyperglycaemia, further increase in insulin secretion, drop of renal blood flow and increased apoptosis. The effects were specific, since they could not be mimicked by replacing glucose with mannose.

CONCLUSION

Anaesthesia-induced hyperglycaemia affects intra-renal auto-regulation via decreased renal perfusion, thus triggering renal function deterioration and tubular injury. Increased intra-renal Angiotensin-II aggravates the damage. Tight hypoglycaemic control might prevent or, at least, attenuate anaesthesia-induced renal injury.

Mechanisms of pressure-diuresis and pressure-natriuresis in Dahl salt-resistant and Dahl salt-sensitive rats

Background

Data on blood flow regulation, renal filtration, and urine output in salt-sensitive Dahl S rats fed on high-salt (hypertensive) and low-salt (prehypertensive) diets and salt-resistant Dahl R rats fed on high-salt diets were analyzed using a mathematical model of renal blood flow regulation, glomerular filtration, and solute transport in a nephron.

Results

The mechanism of pressure-diuresis and pressure-natriuresis that emerges from simulation of the integrated systems is that relatively small increases in glomerular filtration that follow from increases in renal arterial pressure cause relatively large increases in urine and sodium output. Furthermore, analysis reveals the minimal differences between the experimental cases necessary to explain the observed data. It is determined that differences in renal afferent and efferent arterial resistances are able to explain all of the qualitative differences in observed flows, filtration rates, and glomerular pressure as well as the differences in the pressure-natriuresis and pressure-diuresis relationships in the three groups. The model is able to satisfactorily explain data from all three groups without varying parameters associated with glomerular filtration or solute transport in the nephron component of the model.

Conclusions

Thus the differences between the experimental groups are explained solely in terms of difference in blood flow regulation. This finding is consistent with the hypothesis that, if a shift in the pressure-natriuresis relationship is the primary cause of elevated arterial pressure in the Dahl S rat, then alternation in how renal afferent and efferent arterial resistances are regulated represents the primary cause of chronic hypertension in the Dahl S rat.

Biaxial vasoactivity of porcine coronary artery

The passive mechanical properties of blood vessel mainly stem from the interaction of collagen and elastin fibers, but vessel constriction is attributed to smooth muscle cell (SMC) contraction. Although the passive properties of coronary arteries have been well characterized, the active biaxial stress-strain relationship is not known. Here, we carry out biaxial (inflation and axial extension) mechanical tests in right coronary arteries that provide the active coronary stress-strain relationship in circumferential and axial directions. Based on the measurements, a biaxial active strain energy function is proposed to quantify the constitutive stress-strain relationship in the physiological range of loading. The strain energy is expressed as a Gauss error function in the physiological pressure range. In K(+)-induced vasoconstriction, the mean ± SE values of outer diameters at transmural pressure of 80 mmHg were 3.41 ± 0.17 and 3.28 ± 0.24 mm at axial stretch ratios of 1.3 and 1.5, respectively, which were significantly smaller than those in Ca(2+)-free-induced vasodilated state (i.e., 4.01 ± 0.16 and 3.75 ± 0.20 mm, respectively). The mean ± SE values of the inner and outer diameters in no-load state and the opening angles in zero-stress state were 1.69 ± 0.04 mm and 2.25 ± 0.08 mm and 126 ± 22°, respectively. The active stresses have a maximal value at the passive pressure of 80-100 mmHg and at the active pressure of 140-160 mmHg. Moreover, a mechanical analysis shows a significant reduction of mean stress and strain (averaged through the vessel wall). These findings have important implications for understanding SMC mechanics.

Dynamic microvascular blood flow analysis during post-occlusive reactive hyperemia test in patients with schizophrenia

Patients suffering from schizophrenia have an increased mortality risk due to cardiovascular events. Recently the analysis of peripheral circulation has revealed interesting results in the study of vascular pathological conditions assuming that the state of microcirculation of the skin is at least partly representative for the constitution of other vascular beds including those of the cardiac muscle and arteries. The objective of this study was to investigate the microcirculation in patients with acute schizophrenia (PAT, n = 15, mean age 33.0 years, 7 male, 8 female) to identify whether spectral features from blood flow signals derived through laser Doppler spectrometry are significantly altered compared to healthy subjects (CON, n = 15, mean age 32.4 years, 7 male, 8 female) by means of the post-occlusive reactive hyperemia test. It was also explored if a segmentation of the post-ischemic stage can disclose more detailed and additional information about the dynamic behavior of the blood flow during hyperemic response. For this reason, time-frequency analyses were performed to observe the course of the blood flow frequency components over time. Our results indicate significant differences in the patients group, already detectable under baseline conditions but also in the hyperemic phase. The main modifications affect the respiratory (p = 0.006) as well as the cardiac (p = 0.001) activity. It was further shown that the application of a segmented analysis of the post-ischemic state considerably improves the differentiation between both groups. Only with the introduced segmentation algorithm using a window length of 2048 samples and a shift of 128 and 256 samples we could demonstrate influences of the disease on the endothelial (p = 0.029), the sympathetic (p = 0.019) and the myogenic (p = 0.029) mechanisms. These information provide further insights into the appearance of schizophrenia and could lead to an improvement of the patients' treatment to avoid the occurrence of cardiovascular events.

Renal autoregulation and passive pressure-flow relationships in diabetes and hypertension

We investigated renal hemodynamics in isolated, perfused kidneys from rat models of diabetes and hypertension. Autoregulation and passive vascular responses were measured using stepped pressure ramps in the presence of angiotensin II (pEC50) or papaverine (0.1 mM), respectively. Male diabetic heterozygote m(Ren2)27 rats were compared with three male control groups: nondiabetic, normotensive Sprague-Dawley (SD) rats; nondiabetic, hypertensive heterozygote m(Ren2)27 rats; and diabetic, normotensive SD rats. Kidney function (proteinuria, creatinine clearance) was monitored before induction and at monthly intervals. Vascular function was measured in vitro in rats of induction age (6-8 wk) and at 2 and 4 mo postinduction. Renal flow correlated with age, but not diabetes or the Ren2 gene. Kidney weight-specific and body weight-specific renal flow differed between diabetic and nondiabetic rats because diabetic rats had higher kidney but lower body weights. Kidneys from all groups showed effective autoregulation in the presence of angiotensin II. The autoregulatory pressure threshold of m(Ren2)27 rats was higher, and the autoregulation pressure range was wider, compared with SD rats. When vascular smooth muscle activity was blocked with papaverine, pressure-flow responses differed between groups and with time. The m(Ren2)27 rat groups showed higher renal vascular resistance at lower pressures, suggesting greater vascular stiffness. In contrast, diabetic SD rat kidneys demonstrated reduced vessel stiffness. Flow was impaired in diabetic m(Ren2)27 rats at 4 mo, and this correlated with a decline in creatinine clearance. The results suggest that the characteristic late decline in renal filtration function in diabetes- and hypertension-related renal disease follows changes in renal vascular compliance.