Physiological confounders of renal blood flow measurement

Abstract

Objectives: Renal blood flow (RBF) is controlled by a number of physiological factors that can contribute to the variability of its measurement. The purpose of this review is to assess the changes in RBF in response to a wide range of physiological confounders and derive practical recommendations on patient preparation and interpretation of RBF measurements with MRI.

Methods: A comprehensive search was conducted to include articles reporting on physiological variations of renal perfusion, blood and/or plasma flow in healthy humans.

Results: A total of 24 potential confounders were identified from the literature search and categorized into non-modifiable and modifiable factors. The non-modifiable factors include variables related to the demographics of a population (e.g. age, sex, and race) which cannot be manipulated but should be considered when interpreting RBF values between subjects. The modifiable factors include different activities (e.g. food/fluid intake, exercise training and medication use) that can be standardized in the study design. For each of the modifiable factors, evidence-based recommendations are provided to control for them in an RBF-measurement.

Conclusion: Future studies aiming to measure RBF are encouraged to follow a rigorous study design, that takes into account these recommendations for controlling the factors that can influence RBF results.

Keywords: Between-subject variation; Kidney; Perfusion; Renal blood flow; Within-subject variation.

Fig. 1

The absolute change in renal blood flow for all physiological confounders. Each point refers to measurement reported by one empirical study and coded according to the applied method

Fig. 2

The relative change in renal blood flow (%) averaged across studies. Only factors with consistent impact reported in the literature are presented