Selective renal denervation guided by renal nerve stimulation: mapping renal nerves for unmet clinical needs

Renal denervation (RDN) is a well-known innovative therapy for hypertension. However, the effects of global RDN on blood pressure (BP) lowering are quite variable. Insufficient and futile denervation is considered a major factor contributing to the variable results. Mapping renal nerves by renal nerve stimulation (RNS) is the most promising technique to improve the efficacy of RDN. We summarize the clinical and experimental data available regarding RNS-guided RDN and explain the roles of renal efferent nerves, afferent nerves and vagal nerves in BP changes. We further identify five different BP response patterns to RNS and provide an explanation of the underlying neuroanatomical basis.