Autonomic regulation of kidney function

The kidneys play a central role in cardiovascular homeostasis by ensuring a balance between the fluid taken in and that lost and excreted during everyday activities. This ensures stability of extracellular fluid volume and maintenance of normal levels of blood pressure. Renal fluid handling is controlled via neural and humoral influences, with the former determining a rapid dynamic response to changing intake of sodium whereas the latter cause a slower longer-term modulation of sodium and water handling. Activity in the renal sympathetic nerves arises from an integration of information from the high and low pressure cardiovascular baroreceptors, the somatosensory and visceral systems as well as the higher cortical centers. Each sensory system provides varying input to the autonomic centers of the hypothalamic and medullary areas of the brain at a level appropriate to the activity being performed. In pathophysiological states, such as hypertension, heart failure and chronic renal disease, there may be an inappropriate sympathoexcitation causing sodium retention which exacerbates the disease process. The contribution of the renal sympathetic nerves to these cardiovascular diseases is beginning to be appreciated with the demonstration that renal denervation of resistant hypertensive patients results in a long-term normalization of blood pressure.