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1 Department of Medicine,
We determined the effect of postischemic injury to
the human renal allograft on
p-aminohippurate (PAH) extraction
(EPAH) and renal
blood flow. We evaluated renal function in 44 allograft recipients on
two occasions: 1-3 h after reperfusion (day
0) and again on postoperative day
7. On day 0 subsets
underwent intraoperative determination of renal blood flow
(n = 35) by Doppler flow meter and
EPAH
(n = 25) by renal venous assay. Blood
flow was also determined in another subset of 16 recipients on
postoperative day 7 by phase contrast-cine-magnetic resonance imaging, and
EPAH was computed from the
simultaneous PAH clearance. Glomerular filtration rate (GFR) on
day 7 was used to divide subjects into
recovering (n = 23) and sustained
(n = 21) acute renal failure (ARF)
groups, respectively. Despite profound depression of GFR in the
sustained ARF group, renal plasma flow was only slightly depressed,
averaging 296 ± 162 ml · min
1 · 1.73 m2 on day
0 and 202 ± 72 ml · min1 · 1.73 m2 on day
7, respectively. These values did not differ from
corresponding values in the recovering ARF group: 252 ± 133 and 280 ± 109 ml · min1 · 1.73 m2, respectively.
EPAH was profoundly depressed on
day 0, averaging 18 ± 14 and 10 ± 7% in recovering and sustained ARF groups, respectively, vs. 86 ± 6% in normal controls (P < 0.001). Corresponding values on day 7 remained significantly depressed at 65 ± 20 and 11 ± 22%,
respectively. We conclude that postischemic injury to the renal allograft results in profound impairment of
EPAH that persists for at least 7 days, even after the onset of recovery. An ensuing reduction in urinary
PAH clearance results in a gross underestimate of renal plasma flow,
which is close to the normal range in the initiation, maintenance, and
recovery stages of this injury.
p-aminohippurate extraction; organic anion transport; renal plasma flow; phase contrast-cine-magnetic resonance imaging
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