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(Hypertension. 2004;43:699.)
© 2004 American Heart Association, Inc.

Brief Review

Causes and Consequences of Increased Sympathetic Activity in Renal Disease

From the Department of Nephrology and Hypertension, University Medical Center, Utrecht, The Netherlands.

Correspondence to Dr Jaap A. Joles, Department of Nephrology and Hypertension (Room F03.226), University Medical Center, Heidelberglaan 100, P.O. Box 85500, 3508 GA Utrecht, The Netherlands. E-mail J.A.Joles{at}med.uu.nl

Much evidence indicates increased sympathetic nervous activity (SNA) in renal disease. Renal ischemia is probably a primary event leading to increased SNA. Increased SNA often occurs in association with hypertension. However, the deleterious effect of increased SNA on the diseased kidney is not only caused by hypertension. Another characteristic of renal disease is unbalanced nitric oxide (NO) and angiotensin (Ang) activity. Increased SNA in renal disease may be sustained because a state of NO–Ang II unbalance is also present in the hypothalamus. Very few studies have directly compared the efficacy of adrenergic blockade with other renoprotective measures. Third-generation ß-blockers seem to have more protective effects than traditional ß-blockers, possibly via stimulation of NO release. Although it has been extensively documented that muscle SNA is increased in chronic renal failure, data on renal SNA and cardiac SNA are not available for these patients before end-stage renal disease. It is also unknown whether additional treatment with third-generation ß-blockers can delay the progression of renal injury and prevent cardiac injury in chronic renal failure more efficiently than conventional treatment with angiotensin-converting enzyme inhibitors only.

Key Words: renal disease • antihypertensive agents • hypertension • diabetic nephropathy • sympathetic nervous system

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