Abstract-All of the components of a complete dopamine system are present within the kidney, where dopamine acts as a paracrine substance in the control of sodium excretion. Dopamine receptors can be divided into D 1 -like (D 1 and D 5 ) receptors that stimulate adenylyl cyclase and D 2 -like (D 2 , D 3 , and D 4 ) receptors that inhibit adenylyl cyclase. All 5 receptor subtypes are expressed in the kidney, albeit in low copy. Dopamine is synthesized extraneuronally in proximal tubule cells, exported from these cells largely into the tubule lumen, and interacts with D 1 -like receptors to inhibit the Na ϩ -H ϩ exchanger and Na ϩ ,K ϩ -ATPase, decreasing tubule sodium reabsorption. During moderate sodium surfeit, dopamine tone at D 1 -like receptors accounts for Ϸ50% of sodium excretion. In experimental and human hypertension, 2 renal dopaminergic defects have been described: (1) decreased renal generation of dopamine and (2) a D 1 receptor-G protein coupling defect. Both defects lead to renal sodium retention, and each may play an important role in the pathophysiology of essential hypertension. (Hypertension. 2001;38:297-302.) Key Words: receptors, dopamine Ⅲ sodium excretion Ⅲ blood pressure Ⅲ cell signaling D opamine is a catecholamine serving 2 important roles in neurobiology: (1) as an intermediate in the biochemical pathway from the amino acid tyrosine to norepinephrine and epinephrine and (2) as a direct neurotransmitter in its own right. In neurons, dopamine is synthesized by the initial hydroxylation of tyrosine (tyrosine hydroxylase) to L-dihydroxyphenylalanine (L-DOPA) followed by decarboxylation to dopamine (aromatic amino acid decarboxylase). The central neurotransmitter role of dopamine in the regulation of motor function and behavior is well established. More recently, dopamine has been recognized as an important peripheral hormone modulating renal sodium excretion and blood pressure by its cell-to-cell actions within the kidney. 1 The present article reviews evidence for autocrine and paracrine actions of dopamine formed within the kidney, their cellular signaling pathways, and the potential role of dopamine in the pathophysiology of hypertension.
Renal Dopamine Formation and SecretionAlthough the classical pathway for dopamine biosynthesis occurs in neurons, in the kidney dopamine is synthesized independently of nerve activity. Dopamine excreted in urine is almost exclusively derived from intrarenally formed dopamine. 2 Dopamine is formed in large quantities in proximal tubule cells as a result of uptake of filtered L-DOPA via a sodium transporter in the apical membrane. 3 Inside the proximal tubule cell, L-DOPA is rapidly decarboxylated to dopamine by aromatic amino acid decarboxylase, the activity of which is upregulated by high-sodium diet and downregulated by low-salt diet. 4 Essentially nothing is known about the mechanisms by which dopamine is stored in the proximal tubule cell. Dopamine is catabolized in the kidney mainly by catechol-o-methyl-transferase and monoamine oxidase A. 5,6 Dopamin...