Specific desensitization of the canine renal vasculature to angiotensin II despite cyclo-oxygenase inhibition

Intrarenal angiotensin (AII) infusion results in a poorly sustained renal vasoconstrictor response. To examine the relationship between fade and renal tachyphylaxis to AII, sub-pressor doses of AII and norepinephrine (NE) were injected into the renal arteries of anesthetized dogs, resulting in a transient reduction (greater than 50 percent) in renal blood flow. Continuous intrarenal AII infusion, sufficient to reduce renal blood flow by 50 percent, followed. Within five minutes, despite continued AII infusion, substantial recovery (73 +/- 11 percent) of renal blood flow occurred; however, the response to AII bolus injection was lost, but that to NE was sustained. A second group of dogs received indomethacin (5 mg/kg intravenously) 30 minutes prior to the study; the reduction in renal blood flow was better sustained; however, renal tachyphylaxis was still evident.     

Identical mesenteric,femoral and renal vascular responses to angiotensins II and III in the dog

The effects of angiotensin II (AII) and its 1-des Asp analog (AIII) given intra-arterially (0.3–30 ng/kg) were compared in the mesenteric, femoral, and renal vascular beds in anesthetized dogs in which flow was measured with an electromagnetic flowmeter. As has been shown previously, AII and AIII produced similar changes in renal blood flow. In view of the reduced pressor activity of AIII it was surprising to find strikingly similar responses to AII and AIII in the mesenteric and femoral vascular beds. We conclude that the difference in pressor activity of these agents is attributable to something other than differences in their peripheral vascular receptor, and perhaps may be due to differences in their central actions.     

Effects of indomethacin on local blood flow regulation in canine heart and kidney.

In two series of experiments we studied the effects of indomethacin on (a) coronary reactive hyperemia and, (b) renal blood flow, autoregulation, and reactive dilation. Coronary blood flow was measured in closed-chest dogs. Reactive hyperemia was induced by coronary occlusion for 5 and 15 sec. Indomethacin, an inhibitor of prostaglandin synthesis, was infused intra-arterially in doses of 90-200 mg over periods ranging from 30-120 min. Coronary reactive hyperemia was not affected by indomethacin. The canine renal vascular bed was studied under conditions of natural flow, controlled flow, and controlled pressure. Intra-arterial infusion of 90 mg of indomethacin over a 30- to 60- min period caused increased renal vascular resistance and an attenuation of reactive dilation (induced by stopping renal blood flow for 90 sec). Indomethacin slightly attenuated the autoregulatory response to decreasing perfusion pressures, but did not affect the respone to increasing pressures. Thus the study fails to provide evidence for participation of the prostaglandins in regulation of coronary blood flow and suggests only minimal participation of prostaglandings in renal blood flow regulation.     

Influence of angiotensin on the early progression of heart failure

The purpose of this study was to elucidate the role of circulating ANG II in mediating changes in systemic and renal hemodynamics, salt and water balance, and neurohormonal activation during the early progression of heart failure. This objective was achieved by subjecting six dogs to 14 days of rapid ventricular pacing (240 beats/min) while fixing plasma ANG II concentration (by infusion of captopril + ANG II) either at approximately normal (days 1-8, 13-14) or at high physiological (days 9-12) levels. Salt and water retention occurred during the initial days of pacing before sodium and fluid balance was achieved by day 8. At this time, cardiac output and mean arterial pressure were reduced to approximately 55 and 75% of control, respectively; compared with cardiac output, reductions in renal blood flow were less pronounced. Although plasma ANG II concentration was maintained at approximately normal levels, there were sustained elevations in total peripheral resistance (to approximately 135% of control), filtration fraction (to approximately 118% of control), and plasma norepinephrine concentration (to 2-3 times control). During the subsequent high rate of ANG II infusion on days 9-12, there were no additional sustained long-term changes in either systemic or renal hemodynamics other than a further rise in right atrial pressure. However, high plasma levels of ANG II induced sustained antinatriuretic, sympathoexcitatory, and dipsogenic responses. Because these same long-term changes occur in association with activation of the renin-angiotensin system during the natural evolution of this disease, these results suggest that increased plasma levels of ANG II play a critical role in the spontaneous transition from compensated to decompensated heart failure.     

Offset of actions of angiotensin II, angiotensin III, and their analogue antagonists in renal and femoral vascular beds: further evidence for different vascular angiotensin receptors.

Half-time of the offset of antagonist action was used to assess the possibility that factors which determine the duration of action of angiotensin antagonists were responsible for regional differences in their effectiveness: thus, for example, enhanced degradation of angiotensin III analogues in the limb circulation would reduce their effectiveness there despite an angiotensin receptor identical to that in the kidney. In the anesthetized dog blood flow in the renal and femoral vascular beds was measured with an electromagnetic flowmeter; the octapeptide analogue saralasin (1-Sar, 8-Ala AII) and a heptapeptide analogue (des-Asp, 8-Ile AII) were infused intravenously (1 μg/kg/min) for 10 minutes and, after stopping the infusion, the effectiveness of their blockade of angiotensin II was assessed over time. The half-time of offset of the antagonist action was determined from semilogarithmic plots of percent inhibition during recovery. Offset of heptapeptide-induced inhibition in the hindlimb would have been more rapid if increased rate of degradation was the explanation for its reduced effectiveness and such was not the case: Indeed offset was more rapid in the renal (5.8 ± 1.1 min) than the femoral vascular bed (11.7 ± 2.1 min) (p > 0.05). Saralasin showed identical offsets in the two beds (renal 17.2 ± 1.5 min; femoral 15.1 ± 2.9 min) (p > 0.5). Consistent with these observations, the offset of the agonist action of angiotensin III was shorter in the kidney (0.69 ± 0.06 min) than in the limb (1.46 ± 0.13 min; p < 0.001). This study has confirmed the relatively greater efficacy of heptapeptide analogues in the renal than in the femoral vascular bed and has ruled out degradation as accounting for that difference: The difference is most likely to lie in a different angiotensin receptor in the two regions.     

Renal blood flow in normal dogs and in dogs with experimental liver cirrhosis following the acute continuous infusion of endotoxin

The purpose of this study was to determine if the renal circulation of normal and cirrhotic dogs behave similarly in response to an acute endotoxin infusion. Endotoxin was administered as a slow continuous infusion (13-26 micrograms/min) to a total of 20 normal dogs through the femoral vein, portal vein, or into the left renal artery. In each case, there was an initial increment in renal blood flow, of the order of 46%, while arterial blood pressure was actually declining. After 8-20 min, blood flow fell as perfusion pressure declined further. The initial increment in renal perfusion was not due to a hyperthermic response following the endotoxin. When similar doses were given to five dogs with chronic biliary cirrhosis and ascites, the biphasic response in renal perfusion was not observed, rather blood flow declined as perfusion pressure declined. When normal dogs were infused with bilirubin, bile salts, noradrenaline, and angiotensin in pressor doses, the subsequent infusion of endotoxin still produced the usual biphasic response in renal perfusion. Chronic elevation of portal pressure (but not acute elevation), volume contraction by diuresis or hemorrhage, and the infusion of bile intravenously, all abolished the biphasic response in renal perfusion and reproduced in normal dogs the response to endotoxin observed in cirrhotic dogs. Investigation of the factors causing the initial decrease in intrarenal vascular resistance in normal dogs following the endotoxin infusion implicated a role for histamine, kinins, and prostaglandins. We conclude there is a fundamental difference in the response of the renal circulation of normal and cirrhotic dogs to an endotoxin infusion, which may depend on failure of this latter group to release one or more humoral agents. This difference may be due to elevated portal pressure, a decreased effective arterial blood volume, or the products of bile having access to the circulation in cirrhotic dogs.     

Exercise, dobutamine, and combined atropine, norepinephrine, and epinephrine compared

We compared the cardiovascular effects evoked in conscious dogs by 1) submaximal exercise; 2) infusion of dobutamine (40 micrograms X kg-1 X min-1); and 3) infusion of a combination of atropine (0.15 mg/kg), norepinephrine (0.19 micrograms X kg-1 X min-1), and epinephrine (0.05 micrograms X kg-1 X min-1). Myocardial O2 demand, as estimated by the double product (heart rate X systolic blood pressure), was similar during all three interventions. Cardiac output and heart rate increased significantly (P less than 0.05) during each of the three interventions. Arteriovenous O2 difference and total body O2 consumption, however, increased only during submaximal exercise. Although myocardial blood flow increased similarly during each of the three interventions, blood flow to skeletal muscle and the tongue increased only during exercise. Exercise and the combined infusion of atropine, norepinephrine, and epinephrine produced similar increases in blood flow to the diaphragm and similar decreases in blood flow to the stomach. These changes in blood flow were associated with appropriate changes in vascular resistance. Additionally, blood flow to the brain, kidney, adrenal glands, liver, and intestine did not change during any of the three interventions. Thus, in dogs, submaximal exercise, infusion of dobutamine, and infusion of a combination of atropine, norepinephrine, and epinephrine to evoke a given level of estimated myocardial O2 consumption produce similar increases in cardiac output, heart rate, and myocardial blood flow. In contrast, the changes in total body O2 consumption, arteriovenous O2 difference, regional blood flow, and regional vascular resistance that occur during each of these three interventions are different.     

A dynamic model of angiotensin II infusion experiments

Applications of control theory in studies of biological system dynamics have come to be called compartmental modelling. A second order, nonlinear, compartmental model is developed which describes the dynamics of the hormone angiotensin II (AII) and arterial blood pressure (BP) during AII infusion experiments. The model is partially identified using dose response data for constant infusion rates between 0.01 and 0.10 μg/kg/min over a period of several minutes. This study represents a first step in understanding the dynamics of regulation of arterial blood pressure by the renin-angiotensin system. All is a vasoconstrictor and is known to participate in the natural regulation of BP. AII is also believed to be an agent in the development of hypertension and atherosclerosis. The model is used to identify causal mechanisms which are consistent both with the established correlation between plasma AII concentration and arterial BP and with current physiological knowledge. The study demonstrates how a simple state variable model can be used to provide guidance concerning the design of future infusion experiments.     

Adrenergic interactions in uterus and vascular smooth muscle in rats in vivo

Simultaneous blood pressure and uterine responses to norepinephrine infusions were recorded in urethane-anesthetized, pentolinium-indomethacin treated rats in natural estrus under conditions in which no blockers or blockers of alpha 1-, alpha 2-, and beta-adrenergic receptors or of "reuptake" of norepinephrine were present. The contributions of alpha 1- and alpha 2-adrenergic receptors to the blood pressure response were similar during the initial portion of the response. At later times, however, alpha 1-adrenergic receptors were responsible for the major portion of the response. The tachyphylaxis of the pressor response that occurs during norepinephrine infusion could be prevented by preventing norepinephrine "reuptake" with imipramine. In the uterus, the initial small alpha-adrenergic contractile response (seen only at the lowest infusion rate) was quickly overwhelmed by a beta-adrenergic relaxing component. Administration of the beta-adrenergic receptor blocker, propranolol, during norepinephrine infusion caused similar increases in blood pressure in control, yohimbine-, and prazosin-treated rats. Uterine contractions, in contrast, were only significantly elevated during beta-adrenergic receptor blockade when yohimbine or imipramine had also been administered.     

Effects of brain renin-angiotensin on cardiovascular function and saline intake in awake dogs

Initial studies were undertaken to investigate the effects of prolonged administration of angiotensin II (AII), 1 micrograms twice daily, via the lateral ventricles to mongrel dogs on arterial blood pressure and to determine if sodium intake was essential for the development of hypertension. Increasing AII levels in the cerebrospinal fluid for a prolonged period of time produced a sustained hypertensive state only in those dogs in which the daily intake of sodium was increased. The hypertension appeared to be due to an increase in total peripheral resistance. Central administration of AII increased both fluid intake and urine output. In order to assess the hemodynamic effects of increasing endogenous brain AII, renin was injected in doses of 0.025, 0.05, 0.1 and 0.3 units (from porcine kidney) into the lateral ventricles of chronically instrumented awake dogs. Hemodynamic variables were recorded prior to and one and 2 h after the central administration of renin. Renin produced a dose-dependent increase in mean arterial pressure with no significant change in heart rate or carotid, coronary and renal blood flow velocities. Chronic intraventricular administration of renin, 0.15 units twice daily to awake instrumented dogs receiving saline as the drinking fluid, markedly increased the daily intake of saline and increased diastolic and systolic blood pressure without increasing heart rate or carotid, coronary or renal blood flow velocities. There appears to be a direct significant relationship between the increase in mean blood pressure due to the intraventricular administration of renin and the volume of saline consumed.     

Arteriovenous ratios of angiotensin II during acute infusion experiments: a model-based nalysis

The hormone angiotensin II (AII) is a vascocontrictor known to participate in the natural regulation of blood pressure via the renin-angiotensin system. A third-order model was developed which describes the dynamics of venous and arterial plasma AII concentrations (PAC) and mean arterial blood pressure (BP) during acute constant rate AII infusion experiments. The model is calibrated using approximate blood circulation rates and steady-state PAC and BP data for published experiments in sheep. Analysis of the dynamic model demonstrates that local changes in PAC during the first several minutes of acute infusion are characterized by the comparatively rapid distribution of exogenous AII making its forward passage across the blood circulation, combined with the more gradual elevation of exogenous AII recycled through the circulation. This analysis explains the observed divergence in physiological levels of venous and arterial PAC at steady state in terms of the monotonic net clearance of elevated levels of circulating AII along the circulatory path between the point of infusion and the two sites at which the PAC measurements are taken. The model suggests that the differing arteriovenous AII concentration ratios and differing PAC and BP relationships reported for different dose-response experiments may be explained in part by differences in the specific infusion and measurement sites employed in those experiments.     

Effect of volume expansion on hemodynamic variables in nephrectomized dogs

We have previously demonstrated that blood pressure elevation by acute blood volume expansion is volume-dependent during the infusion period and resistance-dependent in the post-infusion period in normal anesthetized dogs, and that such an increase in blood pressure is associated with a potentiation of the pressor response to norepinephrine. To evaluate the possible renal contribution to these hemodynamic changes, blood volume expansion was performed for 1 h with dextran dissolved in lactated Ringer's solution (20 ml/kg) in 15 nephrectomized dogs. The mean blood pressure, cardiac output and total peripheral resistance at the end of infusion were 126%, 225% and 60%, respectively; 3 h after volume expansion they were 126%, 151%, and 92% respectively. However, in 4 dogs, there was an increase in mean blood pressure (138%) 3 h after volume expansion. This was thought to result from an increase in the total peripheral resistance (133%) associated with the recovery of cardiac output (106%). The pressor response to norepinephrine (0.5 microgram/kg) was potentiated after volume expansion. These results indicate that the handling of volume by the kidney contributed to the maintenance of an elevated level of cardiac output. However, nephrectomy did not seem to interfere with the hemodynamic switching of the causative factor for blood pressure elevation from increased cardiac output to increased total peripheral resistance. Neither was the potentiation of pressor response to norepinephrine affected.     

Neural stimulation of gluconeogenesis in isolated pyruvate-perfused rat kidneys

To estimate peritubular norepinephrine concentration during renal nerve stimulation, we compared gluconeogenic responses in isolated pyruvate-perfused rat kidneys with electrical nerve stimulation and exogenous norepinephrine. During 2 and 4 Hz stimulation, venous norepinephrine was 1.7 +/- 0.4 and 2.7 +/- 0.9 nmol/L, respectively. Intra-arterial norepinephrine infusion of 60 pmol/min for 20 min (an amount corresponding to that released during 4 Hz stimulation) resulted in venous norepinephrine levels of 3.6 +/- 0.6 nmol/L. Electrical stimuli (1, 2, and 4 Hz) sustained increases in vascular resistance of 2, 5, and 11% during 20 min of stimulation, while the norepinephrine infusion increased resistance gradually by 8% and a bolus (12.5 nmol/L) transiently increased resistance by 2%. All electrical and norepinephrine interventions, except 1 Hz, decreased fractional Cl excretion. Decreased glomerular filtration rate was observed only during 4 Hz stimulation. Gluconeogenesis transiently increased during stimulation at 2 or 4 Hz (12% (p = 0.056) and 15% (p = 0.028]. The 5% increase in gluconeogenesis during norepinephrine infusion did not differ from the increase during 4 Hz stimulation (p = 0.45). An exogenous norepinephrine bolus (12.5 nmol/L) increased gluconeogenesis 60% for 15 min, four time more than the response to 4 Hz nerve stimulation (p = 0.012). Therefore, we conclude that nerve stimulation sufficient to produce sustained vasoconstriction and antinatriuresis raised norepinephrine concentration less than 12 nmol/L on the peritubular surface of the S1 proximal tubule, thus accounting for the small gluconeogenic response.     

Impaired blood flow autoregulation in nonfiltering kidneys: effects of theophylline administration

To investigate blood flow autoregulation in filtering and nonfiltering kidneys, renal blood flow was determined during graded reductions in renal perfusion pressure in seven anesthetized dogs containing both a filtering and nonfiltering kidney. In each dog, one kidney was made nonfiltering by the method of EH Blaine, JO Davis, and RT Witty (Circ Res 27:1081-1089, 1970). Renal perfusion pressure was decreased from 129 to 115, 99, and 83 mm Hg by stepwise constriction of the suprarenal aorta. In filtering kidneys, the maximum decrease in renal perfusion pressure reduced renal blood flow only 20.1% of control whereas renal blood flow of nonfiltering kidneys decreased by 41.0% of control. During aortic constriction, renal vascular resistance of nonfiltering kidneys remained unchanged or slightly increased. These hemodynamic changes were associated with significantly greater autoregulation indices in nonfiltering kidneys. In eight dogs with nonfiltering kidneys, competitive inhibition of adenosine with theophylline (9 mg/kg iv) restored autoregulation of renal blood flow as shown by significant decreases in renal vascular resistance. These data indicate that in the nonfiltering kidney model, autoregulation of renal blood flow is impaired. It is suggested that this impaired autoregulatory response may result from renal ischemia and the vasoconstrictor influence of elevated intrarenal adenosine concentration.     

Time course of onset and decay of humoral natriuretic activity in the rat.

The natriuretic mechanism.tic activity shown in earlier cross-circulation experiments to develop in the blood of rats undergoing sustained vascular expansion has been further characterized. Following whole blood infusion and urine reinfusion of the donor rat, a cross-circulated isovolaemic partner exhibits a natriuresis of gradual onset, requiring 60-80 min to reach a peak (0.04-3.24 muequiv./min per gram kidney weight). The gradual feature of recipient natriuresis was unchanged by infusing the donor rat 1 h prior to cross-circulation. Once developed, the recipient natriuresis was sustained when fluid depletion by the renal response was prevented, but was reversible with a half-life of about 30 min on interruption of the cross-circulation; reconnection of cross-circulation promptly restored recipient natriuresis. No significant natriuresis (0.04-0.16 muequiv/min per gram kidney weight) occurred in the recipients if the donors in comparable cross-circulations were not infused. These findings confirm that a natriuretic activity develops in the blood as a consequence of vascular expansion, and reveal that the activity has a slowly developing and reversible action on the renal natriure     

Ca2+ antagonists and db-cAMP sustain a rise in renal blood flow induced by acetylcholine in indomethacin-treated dogs

Renal arterial infusion of acetylcholine (ACh) in the dog normally produces a sustained rise in sodium excretion (UNaV) and in renal plasma flow (RPF). When prostaglandin (PG) synthesis is inhibited, ACh induces only a transient increase in UNaV and RPF followed by a progressive decline in UNaV and RPF, and a rise in renin secretory rate (RSR). Renal arterial infusion of PGE2 but not a vasodilator such as bradykinin restored the response to ACh to normal in indomethacin (Indo)-treated dogs. During renal arterial infusion of dibutyryl cyclic AMP (6 mg/min), ACh also produced a sustained increase in UNaV and RPF despite an inhibition of PG synthesis by Indo. Renal arterial infusion of verapamil (60 micrograms/min) or diltiazem (60 micrograms/min) also prevented the subsequent fall in RPF when ACh was infused; RSR, however, did not show a rise. The results suggest that synthesis of PGE2 with stimulation of cAMP is required for sustained ACh action. When PGE synthesis is inhibited, ACh may produce renal vasoconstriction by increasing intracellular Ca2+ concentration. The partial effect of calcium channel blockers suggests that release of calcium from intracellular stores as well as calcium entry may mediate the response.     

Calcium antagonist verapamil inhibits adenosine-induced renal vasoconstriction in the dog

Calcium-dependence of the adenosine-induced renal vasoconstriction was studied in dogs anaesthetized with pentobarbital. Close intraarterial (i.a.) infusion of adenosine (40 and 100 micrograms X min-1) elicited a significant blood flow decrease followed by partial recovery during the 2 min infusion periods as measured with an electromagnetic flow probe. I.a. infusion of verapamil (100 micrograms X min-1) blocked the constrictor response. Verapamil also reduced the vasoconstriction produced by i.a. angiotensin II (0.1 micrograms X min-1) or adrenaline (0.6 micrograms X min-1). Blood pressure remained unchanged throughout all the interventions. The results indicate that the adenosine-induced renal vascular response depends on the availability of extracellular Ca2+ to the contractile mechanism of smooth muscle, a property shared by other well known renal constrictor agents.     

The effect of prolonged infusion and withdrawal of angiotensin II in the spontaneously hypertensive rat

In spontaneously hypertensive rats (SHR) and their normotensive Wistar-Kyoto controls (WKY), prolonged intravenous administration of angiotensin II (AII, 0.2 microgram X kg-1 X min-1 for 3h) resulted in similar increases in arterial blood pressure. Heart rate decreased in WKY and increased in SHR. At the end of the infusion, blood pressure dropped substantially in SHR, but not in WKY: at 5 h after AII withdrawal, blood pressure in SHR had fallen from a control value of 172 +/- 3.3 to 146 +/- 3.9 mmHg (p less than 0.01), whereas pressure in WKY had fallen from 116 +/- 3.0 to 107 +/- 4.2 mmHg (statistically non significant). Thus, pressure at 5 h after AII withdrawal was still substantially higher (p less than 0.01) in the SHR than in the WKY. The results demonstrate that the fall in blood pressure following withdrawal of a prolonged infusion of AII in SHR is much less than that reported to occur following withdrawal of a prolonged infusion of vasopressin (AVP) in SHR.     

Skeletal muscle vasoconstriction produced by prostaglandin synthesis inhibitors; dependence on pump perfusion

A comparison was made of the effect of prostaglandin synthesis inhibitors (PGSI) on systemic blood pressure and hindlimb muscle vascular resistance of anesthetized dogs under different experimental conditions. When muscle blood flow was monitored using an extracorporeal or noncannulating electromagnetic blood flow probe, indomethacin (5 mg/kg i.v.) increased blood pressure slightly, but did not change vascular resistance. Administration of PGSI (indomethacin, meclofenamate, or naproxen, 5 mg/kg i.v.) after 2 hr of pump perfusion of the hindlimb caused a 22% increase in blood pressure, and 39% increase in vascular resistance 30 min afterwards. When administered immediately after instituting pump perfusion, indomethacin caused no significant change in blood pressure or vascular resistance at the 30 min interval, but at 60 min vascular resistance was increased. A similar vasoconstrictor response to indomethacin was obtained when it was infused in a lower dose intraarterially to the hindlimb, or when given i.v. after ligation of the renal pedicles. The results indicate that pump perfusion results in elaboration of a nonrenal prostaglandin(s) which maintains a vasodilator influence on the skeletal muscle vascular bed.     

Obesity augments vasoconstrictor reactivity to angiotensin II in the renal circulation of the Zucker rat

Obesity is an emerging risk factor for renal dysfunction, but the mechanisms are poorly understood. Obese patients show heightened renal vasodilation to blockade of the renin-angiotensin system, suggesting deficits in vascular responses to angiotensin II (ANG II). This study tested the hypothesis that obesity augments renal vasoconstriction to ANG II. Lean (LZR), prediabetic obese (OZR), and nonobese fructose-fed Zucker rats (FF-LZR) were studied to determine the effects of obesity and insulin resistance on reactivity of blood pressure and renal blood flow to vasoconstrictors. OZR showed enlargement of the kidneys, elevated urine output, increased sodium intake, and decreased plasma renin activity (PRA) vs. LZR, and renal vasoconstriction to ANG II was augmented in OZR. Renal reactivity to norepinephrine and mesenteric vascular reactivity to ANG II were similar between LZR and OZR. Insulin-resistant FF-LZR had normal reactivity to ANG II, indicating the insulin resistance was an unlikely explanation for the changes observed in OZR. Four weeks on a low-sodium diet (0.08%) to raise PRA reduced reactivity to ANG II in OZR back to normal levels without effect on LZR. From these data, we conclude that in the prediabetic stages of obesity, a decrease in PRA is observed in Zucker rats that may lead to increased renal vascular reactivity to ANG II. This increased reactivity to ANG II may explain the elevated renal vasodilator effects observed in obese humans and provide insight into early changes in renal function that predispose to nephropathy in later stages of the disease.