RAPID INTRARENAL CIRCULATION

Two causes of shortened intrarenal circulation time were seen. The first is obvious on the angiographic study with a frank arteriovenous shunt caused by either a neoplasm or a malformation. The blood from larger arterial structures courses into venous drainage and the subsequently early venous opacification is seen. The more intriguing and interesting causes were present in patients with either extensive obliterative small vessel disease within the kidney or acute renal artery obstruction. In these individuals a shortened intrarenal circulation time is explained by the "Trueta phenomenon." Here, at a level smaller than can be recorded on the arteriographic examination, shunting must occur from the arterial to the venous side to permit the early venous opacification as was seen on the arteriogram. In the chronic inflammatory group it is the understanding that the disease must be extensive, with the almost total loss of the cortex, since none of the patients demonstrating extensive small vessel disease but an intact cortex, as commonly present in hypertensive patients, had early venous opacification. The pathways for shunting blood are felt to be present in all normal and abnormal kidneys and only become an alternative pathway under markedly abnormal hemodynamic situations.

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