Renal nerves in physiology, pathophysiology and interoception

IF 28.6 1区 医学 Q1 UROLOGY & NEPHROLOGY Nature Reviews Nephrology Pub Date : 2024-10-03 DOI:10.1038/s41581-024-00893-3
Louise C. Evans, Alex Dayton, John W. Osborn
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Abstract

Sympathetic efferent renal nerves have key roles in the regulation of kidney function and blood pressure. Increased renal sympathetic nerve activity is thought to contribute to hypertension by promoting renal sodium retention, renin release and renal vasoconstriction. This hypothesis led to the development of catheter-based renal denervation (RDN) for the treatment of hypertension. Two RDN devices that ablate both efferent and afferent renal nerves received FDA approval for this indication in 2023. However, in animal models, selective ablation of afferent renal nerves resulted in comparable anti-hypertensive effects to ablation of efferent and afferent renal nerves and was associated with a reduction in sympathetic nerve activity. Selective afferent RDN also improved kidney function in a chronic kidney disease model. Notably, the beneficial effects of RDN extend beyond hypertension and chronic kidney disease to other clinical conditions that are associated with elevated sympathetic nerve activity, including heart failure and arrhythmia. These findings suggest that the kidney is an interoceptive organ, as increased renal sensory nerve activity modulates sympathetic activity to other organs. Future studies are needed to translate this knowledge into novel therapies for the treatment of hypertension and other cardiorenal diseases.

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生理、病理生理学和互感中的肾神经
肾交感传出神经在肾功能和血压调节中起着关键作用。肾交感神经活动增加被认为会促进肾钠潴留、肾素释放和肾血管收缩,从而导致高血压。这一假说促成了治疗高血压的导管肾去神经(RDN)技术的发展。2023 年,美国食品和药物管理局批准了两种同时消融肾传出神经和肾传入神经的 RDN 设备用于该适应症。然而,在动物模型中,选择性消融肾传入神经与消融肾传出神经和肾传入神经的抗高血压效果相当,并且与交感神经活动减少有关。选择性传入 RDN 还能改善慢性肾病模型的肾功能。值得注意的是,RDN 的益处不仅限于高血压和慢性肾脏病,还扩展到与交感神经活性升高有关的其他临床病症,包括心力衰竭和心律失常。这些发现表明,肾脏是一个互感器官,因为肾脏感觉神经活动的增加会调节其他器官的交感神经活动。未来的研究需要将这些知识转化为治疗高血压和其他心肾疾病的新疗法。
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来源期刊
Nature Reviews Nephrology
Nature Reviews Nephrology 医学-泌尿学与肾脏学
CiteScore
39.00
自引率
1.20%
发文量
127
审稿时长
6-12 weeks
期刊介绍: Nature Reviews Nephrology aims to be the premier source of reviews and commentaries for the scientific communities it serves. It strives to publish authoritative, accessible articles. Articles are enhanced with clearly understandable figures, tables, and other display items. Nature Reviews Nephrology publishes Research Highlights, News & Views, Comments, Reviews, Perspectives, and Consensus Statements. The content is relevant to nephrologists and basic science researchers. The broad scope of the journal ensures that the work reaches the widest possible audience.
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