The role of the kidney in regulating arterial blood pressure

Abstract

The kidney plays a central role in the regulation of arterial blood pressure. A large body of experimental and physiological evidence indicates that renal control of extracellular volume and renal perfusion pressure are closely involved in maintaining the arterial circulation and blood pressure. Renal artery perfusion pressure directly regulates sodium excretion-a process known as pressure natriuresis-and influences the activity of various vasoactive systems such as the renin-angiotensin-aldosterone system. As a result, many researchers argue that identifying any marked rise in blood pressure requires resetting of the relationship between arterial blood pressure and urinary sodium excretion, which can occur by an array of systemic or local mechanisms. Almost all of the monogenic forms of hypertension affect sites in the kidney associated with sodium handling and transport. Experimental models of spontaneous hypertension, such as the Dahl salt-sensitive rat, have been used to study the effects of kidney transplantation on blood pressure. Results from studies of kidney transplantation indicate that pressure sensitivity to sodium intake 'follows' the kidney, meaning that the recipient of a 'salt-resistant kidney' acquires sodium resistance, and that the recipient of a 'salt-sensitive kidney' acquires pressure sensitivity. The examples above and discussed in this Review demonstrate that it should come as no surprise that most disorders that affect the kidney or the renal vasculature commonly lead to secondary forms of hypertension.

Real-time electrochemical detection of ATP and H2O2release in freshly isolated kidneys

“…The kidney plays a central role in the regulation of arterial blood pressure (5,14,30). RAS hyperactivity is associated with progression of chronic kidney disease and hypertension (22,23).…”

Salt intake in children and its consequences on blood pressure

“…Fluid and sodium balances play a central role in regulating blood pressure and, potentially, in the development of arterial hypertension. Several factors modulate salt handling, such as-among others-activation of the sympathetic nervous system, hyperinsulinemia, hypercalcemia, acid-base balance [8], hyperaldosteronism [8,9], leptin [10], genetic background, and maybe also circulating cardioglycosides [11]. Most of these systems ultimately work through the kidney, with the renin-aldosterone-angiotensin system playing a pivotal role in fluid and sodium homeostasis.…”

Identification of a genetic variant at 2q12.1 associated with blood pressure in East-Asians by genome-wide scan including gene-environment interactions

“…High blood pressure (BP) is one of the most common diseases worldwide and is an important risk factor for cardiovascular and renal disease [1,2]. Homeostasis of blood volume, blood vessel resistance and blood thickness are important for regulation of arterial pressure and these are maintained by complex interactions of several physiological pathways, including hormonal responses, nervous system signaling and intracellular feedback [3,4].…”