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Cited by 167Blood Pressure and Hypertension StudiesRenin-Angiotensin System StudiesChronic Kidney Disease and Diabetes

Sympathetic Nerve Activity Is Inappropriately Increased in Chronic Renal Disease

Klein, Inge H.H.T., Ligtenberg, Gerry, Neumann, Jutta, Oey, P. Liam, Koomans, Hein A., Blankestijn, Peter J.·2003·Journal of the American Society of Nephrology
DOI 10.1097/01.asn.0000098687.01005.a5
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Abstract

The hypothesis that in hypertensive patients with renal parenchymal disease sympathetic activity is "inappropriately" elevated and that this overactivity is a feature of renal disease and not of a reduced number of nephrons per se is addressed. Fifty seven patients with renal disease (various causes, no diabetes, all on antihypertensive medication) were studied, age range 18 to 62, creatinine clearance 10 to 114 ml/min per 1.73 m(2). Antihypertensives were stopped, but diuretics were allowed, to prevent overhydration. Matched control subjects were also studied. The effect of changes in fluid status was examined in seven patients while on and after stopping diuretics and in eight control subjects while on low- and high-sodium diet. Seven kidney donors were studied before and after unilateral nephrectomy. Sympathetic activity was quantified as muscle sympathetic nerve activity (MSNA) in the peroneal nerve. Mean arterial pressure, MSNA, and plasma renin activity were higher in patients than in control subjects, respectively (115 +/- 12 and 88 +/- 11 mmHg, 31 +/- 15 and 18 +/- 10 bursts/min, and 500 [20 to 6940] and 220 [40 to 980] fmol/L per s; P < 0.01 for all items). Extracellular fluid volume (bromide distribution) did not differ. Seven patients were studied again after stopping diuretics. MSNA decreased from 34 +/- 18 to 19 +/- 18 bursts/min (P < 0.01). Eight healthy subjects were studied during low- and high-sodium diet. MSNA was 26 +/- 12 and 13 +/- 7 bursts/min (P < 0.01). The curves relating extracellular fluid volume to MSNA were parallel in the two groups but shifted to a higher level of MSNA in the patients. In the kidney donors, creatinine clearance reduced by 25%, but MSNA was identical before and after donation. It is concluded that in hypertensive patients with renal parenchymal disease, sympathetic activity is inappropriately high for the volume status and that reduction of nephron number in itself does not influence sympathetic activity.

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Crossref · 10.1097/01.asn.0000098687.01005.a5

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  • Sympathetic nervous system activation is present in patients with chronic kidney disease.

    “Sympathetic nervous system activation is present in patients with chronic kidney disease, intimated first with the finding of elevated plasma norepinephrine concentrations100–101, then more definitively with demonstration of whole-body norepinephrine spillover measurements and increased sympathetic nerve firing recorded with clinical microneurography48–51,102.”

    From The Sympathetic Nervous System Alterations in Human Hypertension (2015) · cites this paper as [50]

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Authors
Klein, I. H. H. T., Ligtenberg, G., Neumann, J., Oey, P. L., Koomans, H. A., & Blankestijn, P. J.
Affiliations
University Medical Center Utrecht (NL)
Corresponding author
  • Klein, Inge H.H.T.
  • Ligtenberg, Gerry
  • Neumann, Jutta
  • Koomans, Hein A.
  • Blankestijn, Peter J.
ORCID
Blankestijn, Peter J.
Venue
Journal of the American Society of Nephrology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2003-12
Volume
14
Issue
12
Pages
3239-3244
ISSN
1046-6673 (ISSN-L)
DOI
10.1097/01.asn.0000098687.01005.a5
OpenAlex
W2134037156
Cited by
167
References
26
Citations by year
2026: 4 · 2024: 5 · 2023: 6 · 2022: 4 · 2021: 4 · 2020: 11 · 2019: 11 · 2017: 7 · 2016: 12 · 2015: 7 · 2014: 13 · 2013: 12 · 2012: 12
FWCI
3.07
Type
journal article
Language
en
Open access
closed
Locations
  • Journal of the American Society of Nephrology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
Keywords
sympathetic activity, chronic kidney disease, muscle sympathetic nerve activity, plasma renin activity, hypertension, extracellular volume, sodium intake, diuretics, nephrectomy, kidney donors, renal parenchymal disease, volume status
MeSH terms
Adult, Chronic Disease, Female, Humans, Hypertension, Kidney Diseases, Male, Sympathetic Nervous System

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