Interactions between the sympathetic nervous system and the kidneys in arterial hypertension

Abstract

Elevated sympathetic activity changes renal function and accelerates the development of hypertension. Principles of sympatho-renal interactions in chronic hypertension are reviewed. Alterations in the ontogeny of the sympathetic nervous system and the kidney, inherited abnormalities in sensory receptor function and exaggerated responsiveness to mental stress contribute to inappropriately high sympathetic activity in primary or essential hypertension. Careful characterization of clinical study populations shows that elevated sympathetic activity and "essential" hypertension are not unequivocally associated. Prospective clinical studies which investigate a broader array of physiological functions and experiments in recombinant inbred rodents with less traumatic nerve recording techniques than currently available will help to define under which conditions elevated sympathetic activity is indeed a cause of primary hypertension. Signals arising from the kidney which activate the renin-angiotensin system and afferent renal nerves increase sympathetic activity. These mechanisms importantly contribute to the pathogenesis of hypertension secondary to renal artery stenosis and end-stage renal disease.

Obstructive Sleep Apnea and Kidney Disease: A Potential Bidirectional Relationship?

“…Despite the kidneys being a major source of afferent signals in the sympathetic nervous system, there is much evidence showing that sympathetic hyperactivity worsens kidney function and also leads to renal structural damage. [93][94][95][96][97] Factors that increase sympathetic activity include heart failure, smoking, hypercapnia, and hypoxiarelated sleep disordered breathing. [98][99][100] Somers and associates reported increased sympathetic activity in OSA patients.…”

Neuroendocrine profiling in inherited stress-induced arterial hypertension rat strain with stress-sensitive arterial hypertension

“…Investigation of genetic propensity to increased arterial pressure response to stressful stimulation may be helpful in the prediction of the possible development of hypertension in the time to come (Light et al 1999, Carroll et al 2001, Davrath et al 2003. The prognostic value of the stress responses considerably increased when evaluations were based not only on the blood pressure changes but also on the state of the entire neuroendocrine system, including the pituitaryadrenocortical (Litchfield et al 1998, Whitworth et al 2000, Gold et al 2005, sympathetic adrenal (DiBona 2004, Chou et al 2005, Miyai et al 2005, and renal sodium handling (Genest 2001, Grisk & Rettig 2004. All these systems are directly involved both in the stress response and arterial blood pressure regulation.…”

The relationship between left ventricular diastolic function and the autonomic nervous function in elderly patients with mild-to-moderate essential hypertension

“…Due to the loss of autonomic nervous function balance, the excessive activation of sympathetic nerve was often found in patients with essential hypertension. Studies had shown that: [12][13][14] the unbalanced autonomic nerve function is closely related to the target organ damage including LVDF in patients with early and late essential hypertension. At present, the epidemiological material showed [15][16][17] that the patients with LVDF were often found among those patients with essential hypertension, obesity or diabetes.…”