Sympatho-renal axis in chronic disease

Area of Science:

• Nephrology
• Cardiology
• Endocrinology

Background:

• Excessive central sympathetic drive underlies essential hypertension, insulin resistance, heart failure, and renal dysfunction.
• The renal sympathetic nerves play a critical role as both a cause and consequence of elevated sympathetic activity.
• Coexisting conditions like metabolic syndrome components suggest shared causal pathways linked to sympathetic nervous system activation.

Purpose of the Study:

• To review evidence supporting renal sympathetic nerves as a therapeutic target for diseases associated with excessive sympathetic drive.
• To explore the impact of renal denervation on conditions such as resistant hypertension, insulin resistance, and heart failure.

Main Methods:

• Review of clinical studies on renal denervation using endovascular radiofrequency ablation in patients with resistant hypertension.
• Analysis of data linking renal afferent and efferent sympathetic nerve activity to central sympathetic drive and associated diseases.

Main Results:

• Renal denervation has shown potential in addressing blood pressure, insulin resistance, heart failure congestion, and diuretic resistance.
• Selective impairment of renal nerves reduces markers of central sympathetic drive.
• This approach favorably impacts insulin resistance, heart failure, congestion, and cardiorenal disorders.

Conclusions:

• Renal sympathetic nerves represent a logical therapeutic target for a spectrum of diseases linked by excessive sympathetic drive.
• Renal denervation may offer a simultaneous therapeutic benefit for multiple interconnected conditions.
• Targeting renal nerves provides a unified strategy for managing complex cardiorenal and metabolic disorders.