DEVICE AND METHOD FOR MODULATING RENAL FUNCTION

• US 20080140000A1
• Filed: 12/07/2006
• Published: 06/12/2008
• Est. Priority Date: 12/07/2006
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Shuros, Allan C., Brooke, M. Jason, Poonawala, Tasneem
• Granted Patent: US 7,744,618 B2
• Time in Patent Office: Days
• US Class Current: 604/96.01
• CPC Class Codes: A61M 25/00 Catheters; Hollow probes dilators A61M29/00; peritoneal catheters A61M1/285; tracheal tubes A61M16/04; for drainage A61M27/00; for uterus, vagina or rectum A61M31/00 ; for measuring or testing A61B; materials for catheters A61L29/00
• CPC Class Codes: A61N 1/05 for implantation or insertion into the body, e.g. heart electrode A61N1/06 takes precedence
• CPC Class Codes: A61N 1/36007 of urogenital or gastrointestinal organs, e.g. for incontinence control
• CPC Class Codes: A61N 1/3606 adapted for a particular treatment
• CPC Class Codes: A61N 1/3614 based on impedance measurement

Abstract

Renal function may be modulated by an implantable device having one or more leads or catheters disposed near the kidney via the lymphatic system. In one embodiment, lymphatic drainage from the kidney is modulated to increase or decrease tubular reabsorption of salt and water. The renal function modulation therapy may be delivered in an open-loop or closed-loop fashion, with the latter dependent upon a physiological variable such as blood pressure or cardiac output.

Claims

1. A device, comprising:

a controller contained within an implantable housing; and

,

means operable by the controller for modulating lymphatic flow from a kidney.

2. The device of claim 1 further comprising:

a telemetry transceiver interfaced to the controller; and

,

wherein the controller is programmed to operate the flow modulating means upon receipt of a command to do so via the telemetry transceiver.

3. The device of claim 2 wherein the lymphatic flow modulating means is a means for obstructing lymphatic flow that comprises:

a satellite unit having a telemetry transceiver and a means for obstructing lymphatic flow;

wherein the controller is programmed to operate the means for obstructing lymphatic flow by communicating with the satellite unit.

4. The device of claim 1 wherein the lymphatic flow modulating means is a means for obstructing lymphatic flow that comprises:

a catheter incorporating an expandable balloon adapted for disposition in a renal lymphatic vessel; and

,

a pressurized fluid source for expanding the balloon operable by the controller.

5. The device of claim 1 wherein the lymphatic flow modulating means is a means for augmenting lymphatic flow that comprises:

a catheter adapted for disposition in a renal lymphatic vessel, the catheter having lumen therein for receiving lymphatic fluid; and

,

a pumping mechanism operable by the controller and connected to the catheter for augmenting lymphatic flow by pumping lymphatic fluid from the renal lymphatic vessel.

6. The device of claim 1 further comprising:

pulse generation circuitry operable by the controller; and

,

one or more stimulation electrodes connected to the pulse generation circuitry adapted for endolymphatic disposition near a nerve.

7. The device of claim 1 further comprising:

a drug injector operable by the controller; and

,

a drug delivery catheter connected to the drug injector and adapted for endolymphatic disposition near a kidney.

8. The device of claim 1 wherein the lymphatic flow modulating means is a means for obstructing lymphatic flow and further comprising:

a blood pressure sensor for providing a blood pressure measurement to the controller; and

,

wherein the controller is programmed to operate the obstructing means in closed-loop fashion in dependence upon the blood pressure measurement.

9. The device of claim 1 wherein the lymphatic flow modulating means is a means for obstructing lymphatic flow and further comprising:

a cardiac output sensor for providing a cardiac output measurement to the controller; and

,

wherein the controller is programmed to operate the obstructing means in closed-loop fashion in dependence upon the cardiac output measurement.

10. The device of claim 1 wherein the lymphatic flow modulating means is a means for obstructing lymphatic flow and further comprising:

an exertion level sensor;

a cardiac output sensor; and

,

wherein the controller is programmed to compute a cardiac function index that reflects the adequacy of cardiac output for a particular exertion level and further programmed to operate the obstructing means in closed-loop fashion in dependence upon the computed cardiac function index.

11. The device of claim 1 wherein the lymphatic flow modulating means is a means for obstructing lymphatic flow and further comprising:

a transthoracic impedance sensor for detecting pulmonary edema; and

wherein the controller is programmed to operate the obstructing means in closed-loop fashion in dependence upon the detection of pulmonary edema.

12. The device of claim 1 further comprising:

a physiological variable sensor for measuring or detecting a physiological variable; and

,

wherein the controller is programmed to operate the flow modulating means in closed-loop fashion in dependence upon the sensed or detected physiological variable.

13. The device of claim 12 wherein the physiological variable sensor is adapted for sensing or detecting a physiological variable selected from a group that includes blood pressure, cardiac output, transthoracic impedance, exertion level, blood pH, blood osmolarity, and blood electrolyte concentration.

14. A method, comprising:

implanting an implantable device having a controller and a means operable by the controller for delivering a renal function modulation therapy into a patient; and

,

implanting the therapy delivery means into the patient'"'"'s lymphatic system and at an appropriate site for affecting renal function.

15. The method of claim 14 further comprising introducing a catheter or lead connected to the therapy delivery means into the patient'"'"'s lymphatic system and routing the catheter or lead to an appropriate site for affecting renal function.

16. The method of claim 14 wherein the renal function modulation therapy comprises blocking renal lymphatic flow.

17. The method of claim 14 wherein the renal function modulation therapy comprises augmenting renal lymphatic flow.

18. The method of claim 14 wherein the renal function modulation therapy comprises delivery of a drug directly to the kidney by retrograde infusion through a lymphatic vessel.

19. The method of claim 14 wherein the renal function modulation therapy comprises inhibition or stimulation of a renal nerve or other site affecting renal sympathetic stimulation.

20. The method of claim 14 further comprising programming the controller to deliver renal function modulation therapy upon receipt of a command to do so via telemetry.

21. The method of claim 14 wherein the implantable device includes a sensor for measuring a physiological variable and further comprising programming the device controller to deliver renal function modulation therapy in closed-loop fashion in dependence upon the measured physiological variable.

22. The method of claim 21 wherein the renal function modulation therapy comprises blocking renal lymphatic flow and wherein the physiological variable is blood pressure.

23. The method of claim 21 wherein the renal function modulation therapy comprises blocking renal lymphatic flow and wherein the physiological variable is cardiac output.

24. The method of claim 21 wherein the renal function modulation therapy comprises blocking renal lymphatic flow and wherein the physiological variable is a cardiac function index that reflects the adequacy of cardiac output for a particular exertion level.

25. The method of claim 21 wherein the physiological variable is selected from a group that includes blood pressure, cardiac output, transthoracic impedance, exertion level, blood pH, blood osmolarity, and blood electrolyte concentration.