Nucleus Network Ltd, Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
Hypertens Res. 2010 Jun;33(6):521-8. doi: 10.1038/hr.2010.35. Epub 2010 Mar 26.
Sympathetic nervous system hyperactivity is observed in patients with renal injury, renovascular hypertension, chronic kidney disease (CKD) and end-stage renal disease (ESRD). Elevated sympathetic activity is of prognostic relevance in that plasma norepinephrine concentrations predict survival and the incidence of cardiovascular events in patients with ESRD, as well as future renal injury in normotensive healthy subjects with renal function in the normal range. Renal injury, CKD and ESRD are often associated with obesity, and its common sequelae hypertension and diabetes. In fact, hypertension and diabetes mellitus are the main causes of ESRD in western societies and together account for approximately more than 50% of ESRD incidence in the United States and Japan. Obesity also leads to increases in the incidence of cardiovascular diseases. Several clinical and epidemiological studies have clearly documented that heightened sympathetic nervous activity has an important role in the onset and maintenance of obesity and hypertension. Elevated sympathetic nervous activity may actually represent an important mechanism contributing to the onset and maintenance of renal injury at least in part through its concomitant adverse effects on obesity and hypertension. Understanding the contribution of sympathetic nervous hyperactivity to the onset and maintenance of renal injury might aid in the prevention and treatment of renal injury, CKD and ESRD. Very recently, renal sympathetic denervation was shown to be a potentially novel therapeutic strategy in resistant hypertension. In addition, renin-angiotensin system inhibitors are recommended as the initial therapy because of their renal protective effect, especially in hypertensive patients with type 2 diabetes or with proteinuria. The purpose of this review is to provide an overview of our current knowledge on the relationships between sympathetic nerve activity and renal function to further our understanding of the precise roles of sympathetic nerve activity in renal injury, particularly in the context of obesity and hypertension. These insights may be useful to improve prevention and treatment of renal injury in these patients.
交感神经系统活性亢进可见于肾损伤、肾血管性高血压、慢性肾脏病（CKD）和终末期肾病（ESRD）患者。血浆去甲肾上腺素浓度升高与预后相关，因为它可以预测 ESRD 患者的生存率和心血管事件发生率，也可以预测肾功能正常范围内的正常血压健康受试者未来的肾损伤。肾损伤、CKD 和 ESRD 常与肥胖及其常见并发症高血压和糖尿病相关。事实上，在西方社会，高血压和糖尿病是 ESRD 的主要病因，在美国和日本，这两种病因约占 ESRD 发病率的 50%以上。肥胖也会导致心血管疾病发病率增加。几项临床和流行病学研究清楚地证明，交感神经系统活性增强在肥胖和高血压的发生和维持中起着重要作用。交感神经系统活性升高实际上可能代表了导致肾损伤发生和维持的一个重要机制，至少部分原因是其对肥胖和高血压的不良影响。了解交感神经活性亢进对肾损伤发生和维持的作用可能有助于预防和治疗肾损伤、CKD 和 ESRD。最近的研究表明，肾去交感神经支配可能是治疗难治性高血压的一种新的潜在治疗策略。此外，由于其肾脏保护作用，特别是在高血压合并 2 型糖尿病或蛋白尿的患者中，肾素-血管紧张素系统抑制剂被推荐作为初始治疗药物。本文综述的目的是概述我们目前对交感神经活性与肾功能之间关系的认识，以进一步了解交感神经活性在肾损伤中的确切作用，特别是在肥胖和高血压的背景下。这些见解可能有助于改善这些患者的肾损伤预防和治疗。
