Evans Louise C, Dayton Alex, Osborn John W
Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, MN, USA.
Nat Rev Nephrol. 2025 Jan;21(1):57-69. doi: 10.1038/s41581-024-00893-3. Epub 2024 Oct 3.
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.
肾交感传出神经在肾功能和血压调节中起关键作用。肾交感神经活动增强被认为通过促进肾脏钠潴留、肾素释放和肾血管收缩导致高血压。这一假说促使了基于导管的肾去神经支配术（RDN）用于治疗高血压的发展。两种可消融肾传出和传入神经的RDN设备于2023年获得了美国食品药品监督管理局（FDA）针对该适应症的批准。然而，在动物模型中，选择性消融肾传入神经产生的降压效果与消融传出和传入神经相当，且与交感神经活动降低有关。选择性传入神经RDN在慢性肾脏病模型中也改善了肾功能。值得注意的是，RDN的有益作用不仅限于高血压和慢性肾脏病，还扩展到与交感神经活动增强相关的其他临床病症，包括心力衰竭和心律失常。这些发现表明肾脏是一个内感受器官，因为肾感觉神经活动增加会调节对其他器官的交感神经活动。未来需要开展研究将这一知识转化为治疗高血压和其他心肾疾病的新疗法。
