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5/6th Nephrectomy in Combination with High Salt Diet and Nitric Oxide Synthase Inhibition to Induce Chronic Kidney Disease in the Lewis Rat
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Pathophysiology of resistant hypertension in chronic kidney disease

Vito M Campese1

  • 1Division of Nephrology, Keck School of Medicine, University of Southern California, Los Angeles, CA.

Seminars in Nephrology
|November 23, 2014
PubMed

Insights

Managing hypertension in chronic kidney disease (CKD) requires attention to sodium balance and the sympathetic nervous system. This review covers salt restriction, diuretics, and renal denervation for resistant hypertension in CKD patients.

Area of Science:

  • Nephrology
  • Cardiology
  • Internal Medicine

Background:

  • Hypertension is a common complication in patients with chronic kidney disease (CKD).
  • CKD-associated hypertension is frequently resistant to conventional pharmacologic therapies.
  • Effective management is crucial to slow CKD progression and reduce cardiovascular risk.

Purpose of the Study:

  • To review current strategies for managing hypertension in CKD patients.
  • To discuss the roles of sodium/volume management and the sympathetic nervous system in this population.
  • To explore the potential of dietary salt restriction, diuretics, sequential nephron blockade, and renal denervation.

Main Methods:

  • Literature review focusing on the pathophysiology and treatment of hypertension in CKD.
  • Analysis of studies investigating sodium balance, diuretic use, and sympathetic nervous system modulation.
  • Evaluation of evidence for renal denervation in managing resistant hypertension.

Main Results:

  • Sodium and volume overload significantly contribute to resistant hypertension in CKD.
  • Dietary salt restriction and appropriate diuretic therapy, including sequential nephron blockade, are foundational.
  • The sympathetic nervous system plays a critical role, with renal denervation showing promise.

Conclusions:

  • Optimizing sodium/volume control is essential for managing CKD hypertension.
  • Sequential nephron blockade offers a structured approach to diuretic therapy.
  • Modulating the sympathetic nervous system via renal denervation presents a potential therapeutic avenue for resistant cases.

Keywords:
Hypertensionchronic kidney diseaserenal denervationsodium intakesympathetic nervous system

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