Abstract-Substance P and calcitonin gene-related peptide (CGRP) are colocalized in renal pelvic sensory nerves.Increasing renal pelvic pressure results in an increase in afferent renal nerve activity that is blocked by a substance P receptor antagonist but not by a CGRP receptor antagonist. CGRP potentiates the effects of substance P by preventing the metabolism of substance P. Therefore, we examined whether CGRP enhanced the afferent renal nerve activity responses to substance P and increased renal pelvic pressure, a stimulus known to increase substance P release. Combined administration of substance P and CGRP into the renal pelvis resulted in an increase in afferent renal nerve activity (1392Ϯ217% ⅐ s; area under the curve of afferent renal nerve activity versus time) that was greater (PϽ0.01) than that produced by substance P (620Ϯ156% ⅐ s) or CGRP (297Ϯ96% ⅐ s) alone. Likewise, CGRP enhanced the afferent renal nerve activity response to increased renal pelvic pressure. During renal pelvic administration of the neutral endopeptidase inhibitor thiorphan, the afferent renal nerve activity response to substance P plus CGRP was similar to that produced by either neuropeptide alone. Because these studies suggested that CGRP potentiated the afferent renal nerve activity responses to substance P, we examined whether the afferent renal nerve activity response to CGRP was blocked by a substance P receptor antagonist, RP67580. RP67580 blocked the afferent renal nerve activity response to CGRP by 85Ϯ12% (PϽ0.02). We conclude that CGRP activates renal pelvic sensory nerves by retarding the metabolism of substance P, thereby increasing the amount of substance P available for stimulation of substance P receptors. Key Words: sensory neurons Ⅲ endopeptidase, neutral Ⅲ afferent renal nerve O bstruction to urine flow increases renal pelvic pressure and activates renal mechanosensitive neurons, resulting in an increase in ipsilateral afferent renal nerve activity (ARNA). [1][2][3][4] The increase in ARNA produces a decrease in contralateral efferent renal nerve activity and a contralateral diuresis and natriuresis, known as the contralateral inhibitory renorenal reflex.The mechanosensitive neurons activated in this reflex are mainly located in the renal pelvic wall. 5,6 Activation of substance P receptors in the renal pelvic area plays an essential role in the activation of renal mechanosensitive neurons. [2][3][4] The renal pelvic sensory neurons contain substance P, and increasing renal pelvic pressure increases renal pelvic release of substance P. 3,4 Similar to sensory neurons in other tissues, the renal sensory neurons also contain calcitonin gene-related peptide (CGRP), with substance P and CGRP being colocalized in many neurons. 5,6 Administration of CGRP into the renal pelvis results in an increase in ARNA that is blocked by a CGRP receptor antagonist, suggesting the presence of CGRP receptors in the renal pelvic area. 7 However, blocking these receptors has no effect on the increase in ARNA produced by increased renal...