Renal denervation: a potential new treatment modality for polycystic ovary syndrome?

Area of Science:

• Endocrinology
• Nephrology
• Cardiovascular Medicine

Background:

• Polycystic ovary syndrome (PCOS) is linked to increased sympathetic nervous system activity, insulin resistance, and hypertension.
• Renal denervation is a potential therapeutic strategy for reducing sympathetic outflow and managing blood pressure.

Purpose of the Study:

• To investigate the effects of renal denervation on hemodynamic, metabolic, and renal parameters in obese patients with PCOS and hypertension.
• To assess the impact of renal denervation on sympathetic nerve activity, insulin sensitivity, and renal function.

Main Methods:

• Bilateral renal denervation using percutaneous endovascular radiofrequency ablation.
• Assessment of muscle sympathetic nerve activity and norepinephrine spillover at baseline and 3 months post-procedure.
• Evaluation of insulin sensitivity using euglycemic hyperinsulinemic clamp, along with measurements of cystatin-C, creatinine clearance, and urinary albumin-creatinine ratio.

Main Results:

• Renal denervation substantially reduced muscle sympathetic nerve activity and whole-body norepinephrine spillover.
• A moderate reduction in blood pressure and a significant improvement (approximately 17.5%) in insulin sensitivity were observed.
• Improvements in glomerular hyperfiltration and reductions in urinary albumin excretion were also noted, independent of weight changes.

Conclusions:

• Sympathetic overactivation plays a significant role in the pathophysiology of PCOS.
• Renal denervation demonstrates beneficial effects on blood pressure, insulin sensitivity, and renal function in obese PCOS patients with hypertension.
• These findings support renal denervation as a promising intervention for managing PCOS-related complications.