Stella A
Istituto di Clinica Medica, Università di Milano, Italy.
J Hypertens Suppl. 1992 Dec;10(7):S113-9.
To evaluate the effects of afferent renal nerve activity on reflex control of the cardiovascular system and volume balance.
In the kidney, receptors sensitive to mechanical and chemical stimuli have been identified. Afferent fibres from the kidney have been shown to travel along renal nerves and dorsal roots, mainly from T9 to L4, and to project to the central nervous system at spinal and supraspinal levels. Most of the brainstem regions involved in cardiovascular control and several regions of the anterior hypothalamus (including vasopressin-secreting neurons) receive inputs from renal afferents.
The electrical stimulation of afferent renal nerve fibres can either increase or decrease systemic arterial pressure. The hypertensive response to electrical stimulation of renal afferents is the result of widespread activation of the sympathetic nervous system, leading to an increase in peripheral vascular resistance. Activation of afferent renal nerve fibres by an intrarenal artery infusion of adenosine elicits sustained increases in arterial pressure, heart rate and cardiac output without changing total peripheral resistance, indicating reflex activation of the sympathetic nervous system, predominantly restricted to the heart. An increase in the plasma vasopressin concentration, observed during the electrical stimulation of renal afferents, might help to mediate the hypertensive response to afferent renal nerve stimulation.
The existence of neural renorenal reflexes, by which one kidney can influence the functioning of the opposite kidney, is well established. Contralateral renorenal reflexes, which are inhibitory in nature, are tonically active and mainly control the secretion of renin from juxtaglomerular cells and the tubular reabsorption of sodium and water.
The evidence suggests that sensory information from the kidney contributes to the overall regulation of cardiovascular homeostasis and volume balance.
评估肾传入神经活动对心血管系统反射性控制及容量平衡的影响。
在肾脏中，已鉴定出对机械和化学刺激敏感的感受器。来自肾脏的传入纤维已显示沿肾神经和背根走行，主要从T9至L4，并在脊髓和脊髓上水平投射至中枢神经系统。参与心血管控制的大多数脑干区域以及下丘脑前部的几个区域（包括分泌血管加压素的神经元）接收来自肾传入神经的输入。
肾传入神经纤维的电刺激可升高或降低体循环动脉压。对肾传入神经电刺激的高血压反应是交感神经系统广泛激活的结果，导致外周血管阻力增加。通过肾内动脉输注腺苷激活肾传入神经纤维可引起动脉压、心率和心输出量持续增加，而总外周阻力不变，表明交感神经系统的反射激活主要局限于心脏。在肾传入神经电刺激期间观察到的血浆血管加压素浓度升高可能有助于介导对肾传入神经刺激的高血压反应。
肾-肾反射：神经肾-肾反射的存在已得到充分证实，即一侧肾脏可影响对侧肾脏的功能。对侧肾-肾反射本质上是抑制性的，具有紧张性活动，主要控制肾小球旁细胞肾素的分泌以及钠和水的肾小管重吸收。
证据表明来自肾脏的感觉信息有助于心血管稳态和容量平衡的整体调节。
