Campese V M
Department of Medicine, University of Southern California Medical Center, Los Angeles, USA.
J Nephrol. 1997 Jul-Aug;10(4):184-7.
The association between hypertension and chronic renal disease is well recognized. Various factors may play a role in the pathogenesis of hypertension in chronic renal failure. Those include sodium retention and volume expansion, and increased activity of vasoconstrictors, such as the renin-angiotensin system. More recently, increased activity of the sympathetic nervous system has emerged as a leading factor in the pathogenesis of hypertension in these patients. We have used the model of 5/6 nephrectomized rats to study the role of the sympathetic nervous system in the pathogenesis of this form of hypertension. We have shown greater norepinephrine turnover rate in the posterior hypothalamic nuclei and locus coeruleus of CRF than control rats. Dorsal rhizotomy prevented the rise in blood pressure and the increase in NE turnover rate in the posterior hypothalamus and the locus coeruleus. An acute injury to the kidney produced by intrarenal injection of phenol, causes an immediate rise in blood pressure and in NE secretion from the posterior hypothalamus, that can be prevented by renal denervation. Dorsal rhizotomy prevented the development of hypertension in rats with chronic renal failure. The studies suggest that afferent impulses from the kidney to central integrative structures in the brain may be responsible for the rise in blood pressure in chronic renal failure.
高血压与慢性肾病之间的关联已得到充分认识。多种因素可能在慢性肾衰竭患者高血压的发病机制中发挥作用。这些因素包括钠潴留和血容量扩张，以及血管收缩剂（如肾素 - 血管紧张素系统）活性增加。最近，交感神经系统活性增加已成为这些患者高血压发病机制中的主要因素。我们利用5/6肾切除大鼠模型来研究交感神经系统在这种高血压发病机制中的作用。我们发现，与对照大鼠相比，慢性肾衰竭大鼠下丘脑后部核团和蓝斑中的去甲肾上腺素周转率更高。背根切断术可防止血压升高以及下丘脑后部和蓝斑中去甲肾上腺素周转率的增加。肾内注射苯酚对肾脏造成的急性损伤会导致血压立即升高以及下丘脑后部去甲肾上腺素分泌增加，而肾去神经支配可预防这种情况。背根切断术可防止慢性肾衰竭大鼠发生高血压。这些研究表明，来自肾脏的传入冲动至大脑中的中枢整合结构可能是慢性肾衰竭患者血压升高的原因。
