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Clinical Science
Glomerular Filtration Rate Measured by 51Cr-EDTA Clearance: Evaluation of Captopril-Induced Changes in Hypertensive Patients with and without Renal Artery Stenosis
Anna Alice Rolim Chaves
Corresponding author
annaalice100@yahoo.com.br

Tel: 55 11 3758-6840
, Carlos Alberto Buchpiguel, Jose Nery Praxedes, Luiz Aparecido Bortolotto, Marcelo Tatit Sapienza
Radiology Department, Faculdade de Medicina, Universidade de São Paulo - São Paulo/SP, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle60">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">Renovascular hypertension &#40;RVH&#41; is a potentially curable type of hypertension with an estimated prevalence of 3&#8211;5&#37; in hypertensive patients&#46;<a class="elsevierStyleCrossRefs" href="#bib1">1&#44;2</a> RVH develops from the activation of the renin-angiotensin system due to renal arterial stenosis &#40;RAS&#41;<a class="elsevierStyleCrossRef" href="#bib3">3</a> and subsequent vasoconstriction and retention of sodium and water&#46;</p><p id="para20" class="elsevierStylePara elsevierViewall">RAS can be detected by arteriography and by other noninvasive imaging methods&#44; such as magnetic resonance angiography &#40;MRA&#41;&#44; computed tomography angiography &#40;CTA&#41;&#44; and duplex ultrasound&#46;<a class="elsevierStyleCrossRef" href="#bib4">4</a> The detection of stenosis alone does not guarantee the presence of RVH and may not be sufficient for defining a particular prognosis and treatment&#46;</p><p id="para30" class="elsevierStylePara elsevierViewall">Despite marked technical advances in the endovascular treatment of renal artery occlusive disease&#44; the selection of patients who would benefit from surgical bypass or endovascular therapy remains controversial&#46;<a class="elsevierStyleCrossRef" href="#bib5">5</a> Clinical improvement after vascular intervention is considered diagnostic for RVH&#44; thereby reinforcing the finding that currently available non-invasive techniques are not sufficiently sensitive and specific&#46; Therefore&#44; there is an increasing interest in developing tests to evaluate the functional consequences of RAS to identify patients who may benefit from dilation procedures&#46;<a class="elsevierStyleCrossRef" href="#bib6">6</a></p><p id="para40" class="elsevierStylePara elsevierViewall">Captopril renal scintigraphy is used for the diagnosis of RVH<a class="elsevierStyleCrossRef" href="#bib7">7</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib9">9</a> and is a predictor of blood pressure reduction after surgery or angioplasty&#46; Administration of an angiotensin converting enzyme &#40;ACE&#41; inhibitor leads to a decrease in glomerular filtration pressure&#44; a prolonged transit time of tubular agents &#40;<span class="elsevierStyleSup">99m</span>Tc-MAG3 or EC&#41; and decreased uptake of glomerular agents &#40;<span class="elsevierStyleSup">99m</span>Tc-DTPA&#41;&#46; Captopril renal scintigraphy analysis is based on characterization of renal function deterioration when compared to a baseline study&#44; as a decreased GFR is indirectly reflected in time-activity curves&#46;</p><p id="para50" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSup">51</span>Cr-EDTA clearance provides an accurate and objective measurement of the GFR&#44;<a class="elsevierStyleCrossRef" href="#bib10">10</a> and it can be used to quantify renal function deterioration induced by ACE inhibitors&#46; A simplified method for direct measurement of baseline and post-captopril GFR using <span class="elsevierStyleSup">51</span>Cr-EDTA could add valuable information to the investigation of hypertensive patients with RAS&#44; although scintigraphy would still be needed to assess differential renal function&#46; Assuming that hypertensive patients with RAS have a higher probability of developing RVH than patients without RAS&#44; we hypothesized that an effective test would show a greater decrease in GFR measurements in the first group of patients&#46;</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle70">OBJECTIVES</span><p id="para60" class="elsevierStylePara elsevierViewall">The purpose of this study was to create a one-day protocol to measure baseline and post-captopril GFR with <span class="elsevierStyleSup">51</span>Cr-EDTA&#46;</p></span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle80">METHODS</span><span id="cesec40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle90">Patients</span><p id="para70" class="elsevierStylePara elsevierViewall">From March 2007 to April 2009&#44; 41 consecutive patients with poorly controlled severe hypertension were prospectively included in the study&#46; Patients were recruited from either the Clinical Hospital Nephrology Department or from the Heart Hospital Hypertension Clinic&#44; both of which are tertiary hospitals&#46; Patients with chronic renal insufficiency &#40;those undergoing dialysis or with a Cockcroft-Gault estimated renal function below 15&#47;ml&#47;min&#41; and women who were pregnant or lactating were excluded&#46;</p><p id="para80" class="elsevierStylePara elsevierViewall">All patients had undergone a radiological investigation of RAS within a month prior to their inclusion in the study&#46; The patients were divided into two groups&#58; hypertensive patients with RAS and hypertensive patients without RAS&#46;</p><p id="para90" class="elsevierStylePara elsevierViewall">Clinical data recorded for all patients included&#58; age&#44; sex&#44; time of hypertension onset&#44; blood pressure &#40;BP&#41; level&#44; antihypertensive drugs taken at the time of the study&#44; other atherosclerotic risk factors &#40;dyslipidemia&#44; diabetes&#44; smoking&#41;&#44; and previous history of myocardial infarction &#40;MI&#41; or cerebral ischemia &#40;CI&#41;&#46;</p><p id="para100" class="elsevierStylePara elsevierViewall">The study was approved by the Hospital Ethics Committee&#44; and all patients signed informed consent forms&#46;</p></span><span id="cesec50" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle100">Procedures</span><span id="cesec60" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle110">Baseline and post-captopril GFR</span><p id="para110" class="elsevierStylePara elsevierViewall">Patients were instructed to stop taking antihypertensive drugs &#40;including ACE inhibitors&#41; for three to five days before the study&#46; A single dose of 3&#46;7 MBq &#40;100 &#956;Ci&#41; of <span class="elsevierStyleSup">51</span>Cr-EDTA&#44; in a volume of one ml&#44; was injected into an antecubital vein&#46; The exact injected dose was determined by weighing the syringe before and after the injection on a high precision analytic balance&#46; Accurately timed&#44; nine-ml blood samples were drawn from the opposite arm at two&#44; four&#44; six&#44; and eight hours after the injection&#46; Captopril &#40;50 mg&#41; was orally administered five hours after <span class="elsevierStyleSup">51</span>Cr-EDTA administration&#44; with blood pressure monitoring conducted every fifteen minutes for one hour thereafter&#46;</p><p id="para120" class="elsevierStylePara elsevierViewall">To measure radioisotope activity&#44; the blood samples were centrifuged at 3600 rpm for 10 minutes&#44; and three ml of plasma was measured in a well counter calibrated to the energy of chromium-51 &#40;320 keV&#41;&#46; Each sample&#44; including a three-ml aliquot of a reference solution of 3&#46;7 MBq &#40;100 &#956;Ci&#41; <span class="elsevierStyleSup">51</span>Cr- EDTA diluted to 500 ml in saline&#44; was counted for five minutes&#46;</p><p id="para130" class="elsevierStylePara elsevierViewall">The first two plasma samples &#40;two and four hours&#41; were used to calculate the pre-captopril GFR&#44; and the last two samples &#40;six and eight hours&#41; were used to calculate the post-captopril GFR&#46; Plasma clearance rates were calculated by the slope-intercept method using a single-compartment model&#46; Brochner-Mortensen&#8217;s method was used to correct the systematic error of the slope-intercept technique&#46; The plasma clearance of <span class="elsevierStyleSup">51</span>Cr-EDTA was corrected for a 1&#46;73 m&#178; body surface&#46;</p></span><span id="cesec70" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle120">Evaluation of individual renal function</span><p id="para140" class="elsevierStylePara elsevierViewall">An initial dose of 18&#46;5 MBq &#40;0&#46;5 mCi&#41; of <span class="elsevierStyleSup">99m</span>Tc-DMSA was simultaneously injected with <span class="elsevierStyleSup">51</span>Cr-EDTA&#46; After two hours&#44; anterior and posterior abdominal images were obtained for two minutes using a dual-headed gamma camera &#40;ECam - Siemens&#59; Hoffman Estates&#44; Illinois&#44; USA&#41;&#46; A second dose of 167 MBq &#40;4&#46;5 mCi&#41; of <span class="elsevierStyleSup">99m</span>Tc-DMSA was injected one hour after captopril administration&#44; and a second set of images was acquired at two hours post-administration&#46; Differential renal function was semi-quantitatively estimated in both the baseline and the post-captopril studies by determining the geometric means of the anterior and posterior counts in the right and left kidney regions of interest &#40;<a class="elsevierStyleCrossRef" href="#f1-cln_65p607">Figure 1</a>&#41;&#46;</p><elsevierMultimedia ident="f1-cln_65p607"></elsevierMultimedia></span><span id="cesec80" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle130">Follow-up of patients</span><p id="para150" class="elsevierStylePara elsevierViewall">The group of patients with RAS were followed up to 663 days after their inclusion in the study&#46; BP level and antihypertensive drug classes in use six months after the initial evaluation were used to classify patients as either responders or non-responders to the therapy according to the Guidelines for the Reporting of Renal Artery Revascularization in Clinical Trials&#46;<a class="elsevierStyleCrossRef" href="#bib11">11</a> Improvement in the control of hypertension was defined by a diastolic pressure lower than 90 mmHg and&#47;or a systolic BP lower than 140 mmHg upon use of the same or a less complex scheme of therapy &#40;lower number of antihypertensive drug classes or dosages&#41; or by a reduction in diastolic blood pressure of at least 15 mmHg&#46;</p></span><span id="cesec90" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle140">Data analysis</span><p id="para160" class="elsevierStylePara elsevierViewall">Patient demographics were recorded&#44; and the GFRs before and after captopril administration were compared&#46; The mean&#44; standard deviation&#44; minimum and maximum values were determined for quantitative variables&#46; Absolute and relative frequencies of qualitative variables were also calculated&#46; The Student&#8217;s t test &#40;unpaired&#41; was employed to compare the quantitative variables&#44; and categorical variables were compared by means of Fisher&#8217;s exact test&#46; A p-value &#60; 0&#46;05 was considered significant&#46;</p></span></span></span><span id="cesec100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle150">RESULTS</span><p id="para170" class="elsevierStylePara elsevierViewall">The group of patients with RAS included 21 patients &#40;12 male&#44; nine female&#41;&#46; RAS was confirmed by either arteriography or MRA &#40;in 18 and 3 cases&#44; respectively&#41;&#46; The mean&#177;SD age was 62&#46;1&#177;9&#46;1 years &#40;range 42&#8211;78&#41;&#44; and the time of hypertension onset was 16&#46;2&#177;12&#46;0 years&#46; Patients presented with a mean&#177;SD systolic blood pressure of 161&#177;23 mmHg and a mean&#177;SD diastolic BP of 91&#177;14 mmHg&#46; The mean number &#40;&#177;SD&#41; of antihypertensive drugs in use was 3&#46;9 &#177;1&#46;4&#46;</p><p id="para180" class="elsevierStylePara elsevierViewall">The group of patients without RAS included 20 patients &#40;11 male&#44; nine female&#41;&#46; A non-stenotic renal artery was confirmed by arteriography in 16 cases and MRA and CTA in the remaining four cases&#46; The mean&#177;SD age was 53&#46;1&#177;10&#46;3 years &#40;range 37&#8211;77&#41; and the time of hypertension onset was 12&#46;7&#177;9&#46;4 years&#46; The group of patients without RAS presented with a mean&#177;SD systolic blood pressure of 167&#177;23 mmHg and a mean&#177;SD diastolic BP of 98&#177;14 mmHg&#46; The mean number &#40;&#177;SD&#41; of antihypertensive drugs in use was 4&#46;6&#177;0&#46;9&#46;</p><p id="para190" class="elsevierStylePara elsevierViewall">The group of patients with RAS were significantly older than those without RAS &#40;p-value 0&#46;005&#41;&#44; with no statistically significant difference in the time of hypertension onset &#40;p&#61;0&#46;3&#41;&#44; systolic blood pressure &#40;p&#61;0&#46;44&#41;&#44; diastolic blood pressure &#40;p&#61;0&#46;13&#41;&#44; or number of antihypertensive drugs in use &#40;p&#61;0&#46;08&#41;&#46; There were no significant differences between groups regarding the prevalence of other atherosclerotic risk factors &#40;diabetes and dyslipidemia&#41; or of previous ischemic lesions &#40;MI or CI&#41; &#40;p&#62;0&#46;1&#41;&#46; Clinical and laboratory characteristics of patients with and without RAS are summarized in <a class="elsevierStyleCrossRef" href="#t1-cln_65p607">Table 1</a>&#46;</p><elsevierMultimedia ident="t1-cln_65p607"></elsevierMultimedia><span id="cesec110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle160">Baseline and post-captopril GFR</span><p id="para200" class="elsevierStylePara elsevierViewall">The mean baseline GFR was 48&#46;6&#177;21&#46;8 ml&#47;kg&#47;1&#46;73 m<span class="elsevierStyleSup">2</span> in the group of patients with RAS&#44; which was significantly lower than the GFR of 65&#46;1&#177;28&#46;7 ml&#47;kg&#47;1&#46;73 m<span class="elsevierStyleSup">2</span> in the group without RAS &#40;p&#61;0&#46;04&#41;&#46; Captopril induced a significant reduction of GFR in the group of patients with RAS &#40;to 32&#46;6&#177;14&#46;8 ml&#47; kg&#47;1&#46;73 m<span class="elsevierStyleSup">2</span>&#44; p&#61;0&#46;001&#41; and a non-significant change in the group without RAS &#40;to 62&#46;2&#177;23&#46;6 ml&#47;kg&#47;1&#46;73 m<span class="elsevierStyleSup">2</span>&#44; p&#61;0&#46;68&#41;&#46; The percentage decrease in GFR was also greater in the group of patients with RAS than in the group without RAS &#40;33&#37; and 4&#46;5&#37;&#44; respectively&#44; p&#61;0&#46;007&#41;&#46; Baseline and post-captopril GFR results are summarized in <a class="elsevierStyleCrossRef" href="#f2-cln_65p607">Figure 2</a>&#46;</p><elsevierMultimedia ident="f2-cln_65p607"></elsevierMultimedia></span><span id="cesec120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle170">Evaluation of individual renal function</span><p id="para210" class="elsevierStylePara elsevierViewall">Differential renal function&#44; estimated through pre- and post-captopril <span class="elsevierStyleSup">99m</span>Tc-DMSA scintigraphies&#44; was multiplied by the baseline and post-captopril GFR&#46; The resultant function of each kidney was compared&#44; considering 25 stenotic and 17 non-stenotic units&#46; Stenotic kidneys had a lower baseline GFR than non-stenotic kidneys &#40;18&#46;4 ml&#47;min vs&#46; 32&#46;8 ml&#47;min&#59; p&#61;0&#46;01&#41;&#44; as well as a lower post-captopril GFR &#40;p&#61;0&#46;04&#41;&#59; however&#44; a significant difference in the baseline&#47;post-captopril ratio was not observed &#40;p&#61;0&#46;27&#41;&#46;</p></span><span id="cesec130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle180">Follow-up of patients with RAS</span><p id="para220" class="elsevierStylePara elsevierViewall">Therapy strategies were determined after completion of clinical and radiological investigations&#44; and the decision to treat RAS patients with angioplasty was mainly based on the arteriographic characteristics of the lesion&#46; Optimization of antihypertensive therapy was the therapeutic choice in eleven cases &#40;eight males&#44; 62&#46;8&#177;6 years&#41;&#44; and interventional procedures &#40;angioplasty in nine cases&#44; nephrectomy in one&#41; were adopted in the other ten patients &#40;four males&#44; 61&#46;4&#177;11 years&#41;&#46; No significant difference was found between those patients receiving drugs or submitted to angioplasty regarding age&#44; time of onset of hypertension&#44; number of antihypertensive drugs in use&#44; or systolic blood pressure &#40;171&#177;22 vs&#46; 153&#177;20 mmHg&#44; p&#61;0&#46;07&#41;&#44; but the mean diastolic blood pressure was higher in patients submitted to angioplasty &#40;97&#177;12 vs&#46; 85&#177;14 mmHg&#44; p&#61;0&#46;04&#41;&#46;</p><p id="para230" class="elsevierStylePara elsevierViewall">After a mean follow-up of 379 days &#40;range of 206&#8211;663 days&#41;&#44; 15 patients had a good clinical response&#44; as previously defined&#46; Seven responders had been treated clinically &#40;7&#47;11&#61;63&#37; response rate&#41; and eight had undergone interventions &#40;8&#47;10&#61;80&#37; response rate&#41;&#44; with no significant difference between treatment strategies &#40;p&#61;0&#46;36&#41;&#46; There was a non-significant tendency towards a better response in patients with a higher baseline GFR &#40;responders 53&#46;7&#177;22 ml&#47; min vs&#46; non-responders 36&#46;0&#177;14 ml&#47;min&#44; p&#61;0&#46;09&#41;&#59; however&#44; no differences in the absolute or percentage decrease in GFR after captopril administration were observed&#46; Considering only those 10 patients who received interventional therapy for RAS&#44; no significant difference between responders and non-responders in either the baseline GFR or baseline&#47;post-captopril ratio was observed &#40;p&#61;0&#46;83&#41;&#46;</p></span></span><span id="cesec140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle190">DISCUSSION</span><p id="para240" class="elsevierStylePara elsevierViewall">Use of clinical improvement after vascular intervention as a criterion for diagnosing RVH reinforces that currently available techniques are not sufficiently accurate for this diagnosis&#46; Captopril renal scintigraphy is a predictor of blood pressure reduction after surgery or angioplasty&#44; <a class="elsevierStyleCrossRef" href="#bib7">7</a>&#8211;<a class="elsevierStyleCrossRef" href="#bib9">9</a> but it may be hampered by dehydration&#44; hydronephrosis&#44; or other factors that affect the indirect analysis of renogram curves&#46; A method capable of directly detecting captopril-induced changes in GFR&#44; such as the one presented here&#44; may help to select patients who may benefit from dilation procedures&#46;</p><p id="para250" class="elsevierStylePara elsevierViewall">This study showed that a one-day protocol with sequential measurements of <span class="elsevierStyleSup">51</span>Cr-EDTA clearance could be used to identify captopril-induced changes in GFR&#46; Captopril induced a significantly greater decrease in the GFR of patients with confirmed RAS than in a control group of hypertensive patients without RAS&#46; An exacerbated response to the inhibition of the renin-angiotensin system is a plausible explanation for this finding&#44; although other variables&#44; such as a lower baseline GFR&#44; could have influenced the response&#46;</p><p id="para260" class="elsevierStylePara elsevierViewall">The one-day protocol described in this study is practical for clinical use and avoids the interference of factors such as patient preparation &#40;including hydration status and suspension of antihypertensive drugs&#41;&#46; On the other hand&#44; the comparison of early &#40;two to four-hour&#41; and delayed &#40;six to eight-hour&#41; samples can result in a systematic error of GFR determination&#44; which could be avoided if baseline and post-captopril studies are performed with different injections on different days with sample collection performed at exactly the same intervals&#46; Importantly&#44; a systematic error does not explain the observed difference between groups of patients with and without RAS&#46; The doses of captopril used in renal scintigraphy vary from 25 to 50 mg&#44; leading to a peak plasma level at 40 to 60 minutes after its oral administration&#46; We explored a period during maximum activity of the drug by using a 50 mg captopril dose and collecting plasma samples at six and eight hours &#40;one and three hours after captopril administration&#41;&#46;</p><p id="para270" class="elsevierStylePara elsevierViewall">An important limitation of <span class="elsevierStyleSup">51</span>Cr-EDTA clearance is that an in vitro technique does not permit determination of individual renal function&#46; The global GFR of both kidneys is measured&#44; and a decrease in filtration pressure of a stenotic kidney can be partially compensated for by an increased flow in the contralateral kidney&#46; An experimental study confirmed that a captopril-induced decrease in inulin clearance &#40;31&#37;&#41; occurs in a kidney with RAS&#44; with no significant effect in the contralateral non-RAS kidney&#46;<a class="elsevierStyleCrossRef" href="#bib12">12</a></p><p id="para280" class="elsevierStylePara elsevierViewall">Renal uptake of <span class="elsevierStyleSup">99m</span>Tc-DMSA is strongly reduced after use of an ACE inhibitor in the presence of RVH&#46;<a class="elsevierStyleCrossRef" href="#bib13">13</a> Although DMSA is well known as a tubular agent&#44; the tracer is partially filtered in the glomerulus and is reabsorbed by tubular cells&#44; which explains the observed effect of captopril&#46;<a class="elsevierStyleCrossRef" href="#bib14">14</a> In our study&#44; post-captopril <span class="elsevierStyleSup">99m</span>Tc-DMSA scintigraphy showed no significant variation in differential function as compared to the baseline study&#44; even in patients with RAS and with significant decreases in the global GFR&#46; DMSA uptake mechanisms are not completely understood&#44; and a proportion of 35&#37; GFR to 65&#37; direct tubular uptake has been proposed by some authors&#46;<a class="elsevierStyleCrossRef" href="#bib14">14</a> DMSA uptake may be only partially or not influenced by a decrease in GFR if reabsorption of filtered radiopharmaceuticals is not the dominant mechanism in chronically ischemic or poorly functioning kidneys&#46;</p><p id="para290" class="elsevierStylePara elsevierViewall">The lack of a direct comparison to captopril renography is the main limitation of this study because the functional significance of detected RAS is not clear&#46; When the present study was designed&#44; we believed that the clinical response to angioplasty would be the final criterion for RVH diagnosis&#46; DTPA renal scintigraphy was performed in a non-systematic manner only when requested by the nephrologists&#46; Captopril renography results may be influenced by different interpretation criteria<a class="elsevierStyleCrossRef" href="#bib15">15</a> and are usually less accurate in azotemic patients&#46; When performed in patients with ischemic nephropathy or a poorly functioning kidney&#44; as many as 50&#37; of the studies suggest an indeterminate probability of RVH&#46;<a class="elsevierStyleCrossRefs" href="#bib16">16&#44;17</a> Absolute GFR measurement increases renogram sensitivity&#44; and the combined analysis of renogram and GFR resulted in a specificity of 100&#37; for exclusion of RAS in a prospective study of thirty hypertensive patients&#46;<a class="elsevierStyleCrossRef" href="#bib18">18</a></p><p id="para300" class="elsevierStylePara elsevierViewall">Plasma clearance of <span class="elsevierStyleSup">51</span>Cr-EDTA can be used to estimate GFR with high accuracy&#44; and it is one of the best available indices of renal function&#44; even for patients with a GFR as low as 15 ml&#47;min&#46;<a class="elsevierStyleCrossRef" href="#bib19">19</a> Quantitative determination of baseline and post-captopril GFR with EDTA could reduce the number of indeterminate results even in those patients with poor renal function&#46;<a class="elsevierStyleCrossRef" href="#bib9">9</a> However&#44; evaluation of atrophic&#47;hypo-functioning kidneys may be limited by the precision of measurements &#40;improved with in vitro <span class="elsevierStyleSup">51</span>Cr-EDTA clearance&#41; and by the coexistence of different vascular and fluid retention mechanisms in the genesis of hypertension&#46;</p><p id="para310" class="elsevierStylePara elsevierViewall">Although the worsening of renal function following captopril administration is taken as an indicator of RVH&#44; baseline&#47;post captopril changes in GFR ratios did not allow for discrimination of responders to revascularization procedures from non-responders&#44; limiting the clinical implication of this study&#46;</p><p id="para320" class="elsevierStylePara elsevierViewall">The small number of patients and non-randomization of therapeutic procedures do not allow for a definitive conclusion to be drawn regarding the prognostic significance of the method&#46;</p></span><span id="cesec150" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle200">CONCLUSION</span><p id="para330" class="elsevierStylePara elsevierViewall">In conclusion&#44; the baseline and post-captopril GFR can be quantitatively measured by <span class="elsevierStyleSup">51</span>Cr-EDTA clearance in a one-day procedure&#44; thereby allowing for avoidance of any variation in preparation or other clinical conditions&#46;</p><p id="para340" class="elsevierStylePara elsevierViewall">Captopril induces a significantly greater drop in the GFR of hypertensive patients with RAS than in those without RAS&#44; although this decrease was not related to a clinical response after intervention in this limited number of cases&#46;</p></span></span>"
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          "titulo" => "INTRODUCTION"
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                  "identificador" => "cesec60"
                  "titulo" => "Baseline and post-captopril GFR"
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                  "identificador" => "cesec70"
                  "titulo" => "Evaluation of individual renal function"
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                  "titulo" => "Follow-up of patients"
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                  "titulo" => "Data analysis"
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          "titulo" => "RESULTS"
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              "identificador" => "cesec110"
              "titulo" => "Baseline and post-captopril GFR"
            ]
            1 => array:2 [
              "identificador" => "cesec120"
              "titulo" => "Evaluation of individual renal function"
            ]
            2 => array:2 [
              "identificador" => "cesec130"
              "titulo" => "Follow-up of patients with RAS"
            ]
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        ]
        5 => array:2 [
          "identificador" => "cesec140"
          "titulo" => "DISCUSSION"
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          "identificador" => "cesec150"
          "titulo" => "CONCLUSION"
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          "titulo" => "REFERENCES"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2010-01-17"
    "fechaAceptado" => "2010-03-24"
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          "clase" => "keyword"
          "titulo" => "KEYWORDS&#58;"
          "identificador" => "xpalclavsec1582709"
          "palabras" => array:5 [
            0 => "Renal Artery Obstruction"
            1 => "Renovascular Hypertension"
            2 => "Glomerular Filtration Rate"
            3 => "Chromium EDTA"
            4 => "Angiotensin-Converting Enzyme Inhibitors"
          ]
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    "resumen" => array:1 [
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        "resumen" => "<span id="ceabs10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">INTRODUCTION&#58;</span><p id="spara40" class="elsevierStyleSimplePara elsevierViewall">Renal artery stenosis can lead to renovascular hypertension&#59; however&#44; the detection of stenosis alone does not guarantee the presence of renovascular hypertension&#46; Renovascular hypertension depends on activation of the renin-angiotensin system&#44; which can be detected by functional tests such as captopril renal scintigraphy&#46; A method that allows direct measurement of the baseline and post-captopril glomerular filtration rate using chromium-51 labeled ethylenediamine tetraacetic acid &#40;<span class="elsevierStyleSup">51</span>Cr-EDTA&#41; could add valuable information to the investigation of hypertensive patients with renal artery stenosis&#46; The purposes of this study were to create a protocol to measure the baseline and post-captopril glomerular filtration rate using <span class="elsevierStyleSup">51</span>Cr-EDTA&#44; and to verify whether changes in the glomerular filtration rate permit differentiation between hypertensive patients with and without renal artery stenosis&#46;</p></span> <span id="ceabs20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">METHODS&#58;</span><p id="spara50" class="elsevierStyleSimplePara elsevierViewall">This prospective study included 41 consecutive <span class="elsevierStyleItalic">patients</span> with poorly controlled severe hypertens<span class="elsevierStyleItalic">ion</span>&#46; All patients had undergone a radiological investigation of renal artery stenosis within the month prior to their inclusion&#46; The patients were divided into two groups&#58; patients with &#40;n&#61;21&#41; and without renal artery stenosis&#44; &#40;n&#61;20&#41;&#46; In vitro glomerular filtration rate analysis &#40;<span class="elsevierStyleSup">51</span>Cr-EDTA&#41; and <span class="elsevierStyleSup">99m</span>Tc-DMSA scintigraphy were performed before and after captopril administration in all patients&#46;</p></span> <span id="ceabs30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">RESULTS&#58;</span><p id="spara60" class="elsevierStyleSimplePara elsevierViewall">The mean baseline glomerular filtration rate was 48&#46;6&#177;21&#46;8 ml&#47;kg&#47;1&#46;73 m<span class="elsevierStyleSup">2</span> in the group wuth renal artery stenosis&#44; which was significantly lower than the GFR of 65&#46;1&#177;28&#46;7 ml&#47;kg&#47;1&#46;73m<span class="elsevierStyleSup">2</span> in the group without renal artery stenosis &#40;p&#61;0&#46;04&#41;&#46; Captopril induced a significant reduction of the glomerular filtration rate in the group with renal artery stenosis &#40;to 32&#46;6&#177;14&#46;8 ml&#47; kg&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#44; p&#61;0&#46;001&#41; and an insignificant change in the group without RAS &#40;to 62&#46;2&#177;23&#46;6 ml&#47;kg&#47;1&#46;73m<span class="elsevierStyleSup">2</span>&#44; p&#61;0&#46;68&#41;&#46; Scintigraphy with technetium-99m dimercapto-succinic acid &#40;DMSA&#41; did not show significant differences in differential renal function from baseline to post-captopril images in either group&#46;</p></span> <span id="ceabs40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle40">CONCLUSIONS&#58;</span><p id="spara70" class="elsevierStyleSimplePara elsevierViewall">Captopril induced a decrease in the GFR that could be quantitatively measured with <span class="elsevierStyleSup">51</span>Cr-EDTA&#46; The reduction is more pronounced in hypertensive patients with RAS&#46;</p></span>"
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            "titulo" => "METHODS&#58;"
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          "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">General sequence of the protocol&#44; including radiopharmaceutical administration and sample intervals&#46;</p>"
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          "en" => "<p id="spara20" class="elsevierStyleSimplePara elsevierViewall">GFR before and after captopril administration in groups RAS and no-RAS&#46; Group RAS exhibited a lower GFR at baseline and a significantly greater drop in the GFR after captorpril administration&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">CLINICAL CHARACTERISTICS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">Group RAS &#40;n&#61;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">Group no-RAS &#40;n&#61;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">62&#46;1&#177;9&#46;1 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">53&#46;1&#177;10&#46;3 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">time of onset of hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">16&#46;2&#177;12&#46;0 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">12&#46;7&#177;9&#46;4 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Systolic Blood Pressure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">161&#177;23 mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">167&#177;23 mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Diastolic Blood Pressure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">91&#177;14 mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">98&#177;14 mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Number of medications in use&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">3&#46;9 &#177;1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">4&#46;6&#177;0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">9 &#40;42&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">8 &#40;40&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Dyslipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">20 &#40;95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">18 &#40;90&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Smoking &#40;current&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">4 &#40;19&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">6 &#40;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Smoking &#40;previous&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">12 &#40;57&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">5 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Myocardial infarction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">5 &#40;23&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">6 &#40;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Cerebral ischemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">2 &#40;9&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">5 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">LABORATORY TEST RESULTS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Creatinine &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;6 &#177; 0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;4 &#177;0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Urea &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">58&#46;0 &#177;28&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">43&#46;8 &#177;21&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Cholesterol &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">188&#46;8 &#177;48&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">205&#46;8 &#177;42&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Triglycerides &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">180&#46;6 &#177;145&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">154&#46;9 &#177;83&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top" style="border-bottom: 2px solid black">Blood glucose &#40;mg&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top" style="border-bottom: 2px solid black">110&#46;0 &#177;29&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top" style="border-bottom: 2px solid black">142&#46;4 &#177;70&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spara30" class="elsevierStyleSimplePara elsevierViewall">Clinical and laboratorial characteristics of patients in Groups RAS and no-RAS&#46;</p>"
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      "titulo" => "REFERENCES"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "cebibsec10"
          "bibliografiaReferencia" => array:19 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis and treatment of renovascular hypertension&#58; a cost-benefit analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              JP Bolduc \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              VL Oliva \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              E Therasse \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              MF Giroux \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              L Bouchard \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              P Perreault \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2214/ajr.184.3.01840931"
                      "Revista" => array:6 [
                        "tituloSerie" => "AJR Am J Roentgenol"
                        "fecha" => "2005"
                        "volumen" => "184"
                        "paginaInicial" => "931"
                        "paginaFinal" => "937"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15728620"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of MR angiography on the diagnosis and treatment of patients with suspected renovascular disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              RA Omary \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              KP Henseler \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              R Salem \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              JC McDermott \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              I Sproat \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              M Wojtowycz \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s1051-0443(07)61677-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Vasc Interv Radiol"
                        "fecha" => "2001"
                        "volumen" => "12"
                        "paginaInicial" => "1179"
                        "paginaFinal" => "1183"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11585884"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Contemporary imaging techniques for the diagnosis of renal artery stenosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              T Leiner \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              MW de Haan \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              PJ Nelemans \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              JM van Engelshoven \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              GB Vasbinder \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00330-005-2826-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Radiol"
                        "fecha" => "2005"
                        "volumen" => "15"
                        "paginaInicial" => "2219"
                        "paginaFinal" => "2229"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15983776"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treating renal artery stenosis&#46; A statement pro endovascular therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => """
                              M Schillinger \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              E Minar \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              R Ahmadi \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00059-004-2533-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Herz"
                        "fecha" => "2004"
                        "volumen" => "29"
                        "paginaInicial" => "68"
                        "paginaFinal" => "75"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14968343"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The management of renal artery atherosclerosis for renal salvage&#58; does stenting help"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              VS Kashyap \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              RN Sepulveda \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              JF Bena \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              JV Nally \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              ED Poggio \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              RK Greenberg \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Vasc Surg"
                        "fecha" => "2007"
                        "volumen" => "45"
                        "paginaInicial" => "1101"
                        "paginaFinal" => "1108"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "New intrarenal echo-Doppler velocimetric indices for the diagnosis of renal artery stenosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              M Bardelli \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              F Veglio \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              E Arosio \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              A Cataliotti \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              E Valvo \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              A Morganti \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Kidney Int"
                        "fecha" => "2006"
                        "volumen" => "69"
                        "paginaInicial" => "3580"
                        "paginaFinal" => "3587"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Captopril radionuclide test in renovascular hypertension&#58; a European multicentre study&#46; European Multicentre Study Group"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              E Fommei \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              S Ghione \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              AJ Hilson \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              L Mezzasalma \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              HY Oei \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              A Piepsz \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/BF00176558"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Nucl Med"
                        "fecha" => "1993"
                        "volumen" => "20"
                        "paginaInicial" => "617"
                        "paginaFinal" => "623"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8370384"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Captopril renography and the effect of percutaneous transluminal angioplasty on blood pressure in 94 patients with renal artery stenosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              GG Geyskes \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              AJ de Bruyn \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ajh/4.12.685s"
                      "Revista" => array:7 [
                        "tituloSerie" => "Am J Hypertens"
                        "fecha" => "1991"
                        "volumen" => "4"
                        "numero" => "12 Pt 2"
                        "paginaInicial" => "685S"
                        "paginaFinal" => "689S"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1837991"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Captopril renoscintigraphy with Tc-99m DTPA in patients with suspected renovascular hypertension&#46; Prospective and retrospective evaluation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              K Itoh \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              E Tsukamoto \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              K Nagao \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              K Nakada \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              K Kanegae \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              M Furudate \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00003072-199306000-00001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Nucl Med"
                        "fecha" => "1993"
                        "volumen" => "18"
                        "paginaInicial" => "463"
                        "paginaFinal" => "471"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8319397"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Validation of plasma clearance of 51Cr-EDTA in adult renal transplant recipients&#58; comparison with inulin renal clearance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              FS Medeiros \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              MT Sapienza \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              ES Prado \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              F Agena \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              MH Shimizu \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              FB Lemos \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1432-2277.2008.00799.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Transpl Int"
                        "fecha" => "2009"
                        "volumen" => "22"
                        "paginaInicial" => "323"
                        "paginaFinal" => "331"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19055616"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for the reporting of renal artery revascularization in clinical trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              JH Rundback \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              D Sacks \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              KC Kent \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              C Cooper \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              D Jones \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              T Murphy \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.rvi.0000094621.61428.d5"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Vasc Interv Radiol"
                        "fecha" => "2003"
                        "volumen" => "14"
                        "numero" => "9 Pt 2"
                        "paginaInicial" => "S477"
                        "paginaFinal" => "S492"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14514863"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Captopril renography in two kidney and one kidney Goldblatt hypertension in dogs"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              JV Nally Jr \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              HS Clarke Jr \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              BK Gupta \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              ML Gross \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              LR Low \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              WJ Potvin \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Nucl Med"
                        "fecha" => "1987"
                        "volumen" => "28"
                        "paginaInicial" => "1171"
                        "paginaFinal" => "1179"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3298573"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Enalaprilat-enhanced renography in a rat model of renovascular hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              RT Kopecky \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              JG McAfee \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              FD Thomas \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              GH Anderson Jr \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              B Hellwig \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              M Roskopf \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Nucl Med"
                        "fecha" => "1990"
                        "volumen" => "31"
                        "paginaInicial" => "501"
                        "paginaFinal" => "507"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2157832"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Renal handling of technetium-99m DMSA&#58; evidence for glomerular filtration and peritubular uptake"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              MJ de Lange \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              DA Piers \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              JG Kosterink \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              WH van Luijk \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              S Meijer \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              ZD de \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Nucl Med"
                        "fecha" => "1989"
                        "volumen" => "30"
                        "paginaInicial" => "1219"
                        "paginaFinal" => "1223"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2544699"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Captopril renal scintigraphy&#8211;a way to distinguish functional from anatomic renal artery stenosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              HR Black \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Nucl Med"
                        "fecha" => "1992"
                        "volumen" => "33"
                        "paginaInicial" => "2045"
                        "paginaFinal" => "2046"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1432171"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Should the role of captopril renography extend to the evaluation of chronic renal disease&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              MD Blaufox \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Nucl Med"
                        "fecha" => "1994"
                        "volumen" => "35"
                        "paginaInicial" => "254"
                        "paginaFinal" => "256"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8294994"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prospective study of simultaneous orthoiodohippurate and diethylenetriaminepentaacetic acid captopril renography&#46; The Einstein&#47;Cornell Collaborative Hypertension Group"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              MD Blaufox \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              EJ Fine \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              S Heller \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              J Hurley \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              M Jagust \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              Y Li \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Nucl Med"
                        "fecha" => "1998"
                        "volumen" => "39"
                        "paginaInicial" => "522"
                        "paginaFinal" => "528"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9529303"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Individual kidney glomerular filtration rate in the interpretation of non-diagnostic curves on captopril renography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              R Kumar \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              AK Padhy \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              S Machineni \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              AK Pandey \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              A Malhotra \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00006231-200007000-00007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nucl Med Commun"
                        "fecha" => "2000"
                        "volumen" => "21"
                        "paginaInicial" => "637"
                        "paginaFinal" => "643"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10994667"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The basics of renal imaging and function studies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              E Durand \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              A Prigent \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Q J Nucl Med"
                        "fecha" => "2002"
                        "volumen" => "46"
                        "paginaInicial" => "249"
                        "paginaFinal" => "267"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12411866"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
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