2007 JASN IMPACT FACTOR 7.111	HOME   AUTHOR INFO   EDITORIAL BOARD   SUBSCRIBE   FEEDBACK   ALERTS   HELP
advanced	CURRENT ISSUE	ARCHIVES	JASN Express	ONLINE SUBMISSION

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Koomans, H. A. Articles by Joles, J. A. Search for Related Content PubMed PubMed Citation Articles by Koomans, H. A. Articles by Joles, J. A.

Sympathetic Hyperactivity in Chronic Renal Failure: A Wake-up Call

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

Correspondence to Dr. Hein A. Koomans, Department of Nephrology and Hypertension, University Medical Center Utrecht, Room F03.223, P.O. Box 85500, 3508 GA Utrecht, The Netherlands. Phone: 31-30-2507329; Fax: 31-30-2543492; E-mail: H.A.Koomans{at}azu.nl

ABSTRACT. Sympathetic hyperactivity plays an important and distinct role in hypertension associated with chronic renal failure (CRF). Renal ischemia, elevated angiotensin II, and suppressed brain nitric oxide (NO) all stimulate sympathetic activity. Evidence is accumulating for a role of sympathetic hyperactivity in renal and cardiac damage in patients with CRF. Decreased NO availability and increased oxidative stress, characteristic in CRF patients, seem to sensitize target organs for damaging actions of sympathetic hyperactivity. Fortunately, sympatholytic agents can slow down progression of renal and cardiac dysfunction. Angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists suppress sympathetic activity, but complete elimination of the effect of sympathetic hyperactivity can be obtained only with specific adrenergic blockers. However, this important therapeutic option is grossly neglected, painfully illustrated by the unwillingness to treat CRF patients with -blockers, even if they have had a myocardial infarction. After discussion of mechanisms and effects of the sympathetic hyperactivity, a case is made for increased application of specific adrenergic blockers in patients with CRF.

This article has been cited by other articles:

				N. A. Lutaif, E. M. Rocha, L. A.Veloso, L. M. Bento, and J. A. R. Gontijo Renal contribution to thermolability in rats: role of renal nerves Nephrol. Dial. Transplant., December 1, 2008; 23(12): 3798 - 3805. [Abstract] [Full Text] [PDF]

				Y. Wang, D. Babankova, J. Huang, G. M. Swain, and D. H. Wang Deletion of Transient Receptor Potential Vanilloid Type 1 Receptors Exaggerates Renal Damage in Deoxycorticosterone Acetate-Salt Hypertension Hypertension, August 1, 2008; 52(2): 264 - 270. [Abstract] [Full Text] [PDF]

				M. Chonchol, M. Benderly, and U. Goldbourt Beta-blockers for coronary heart disease in chronic kidney disease Nephrol. Dial. Transplant., July 1, 2008; 23(7): 2274 - 2279. [Abstract] [Full Text] [PDF]

				E. Ritz and C. Wanner The Challenge of Sudden Death in Dialysis Patients Clin. J. Am. Soc. Nephrol., May 1, 2008; 3(3): 920 - 929. [Full Text] [PDF]

				G. Li, J. Xu, P. Wang, H. Velazquez, Y. Li, Y. Wu, and G. V. Desir Catecholamines Regulate the Activity, Secretion, and Synthesis of Renalase Circulation, March 11, 2008; 117(10): 1277 - 1282. [Abstract] [Full Text] [PDF]

				R. M. Salem, P. E. Cadman, Y. Chen, F. Rao, G. Wen, B. A. Hamilton, B. K. Rana, D. W. Smith, M. Stridsberg, H. J. Ward, et al. Chromogranin A Polymorphisms Are Associated With Hypertensive Renal Disease J. Am. Soc. Nephrol., March 1, 2008; 19(3): 600 - 614. [Abstract] [Full Text] [PDF]

				J. Neumann, G. Ligtenberg, I. H.T. Klein, P. Boer, P. L. Oey, H. A. Koomans, and P. J. Blankestijn Sympathetic Hyperactivity in Hypertensive Chronic Kidney Disease Patients Is Reduced During Standard Treatment Hypertension, March 1, 2007; 49(3): 506 - 510. [Abstract] [Full Text] [PDF]

				K. E. Jie, M. C. Verhaar, M.-J. M. Cramer, K. van der Putten, C. A. J. M. Gaillard, P. A. Doevendans, H. A. Koomans, J. A. Joles, and B. Braam Erythropoietin and the cardiorenal syndrome: cellular mechanisms on the cardiorenal connectors Am J Physiol Renal Physiol, November 1, 2006; 291(5): F932 - F944. [Abstract] [Full Text] [PDF]

				M. Ravera, M. Re, L. Deferrari, S. Vettoretti, and G. Deferrari Importance of Blood Pressure Control in Chronic Kidney Disease J. Am. Soc. Nephrol., April 1, 2006; 17(4_suppl_2): S98 - S103. [Abstract] [Full Text] [PDF]

				K. Tsuda, M. C. Bowers, K. A. Katki, A. Rao, M. Koehler, P. Patel, A. Spiekerman, D. J. DiPette, and S. C. Supowit Calcitonin Gene-Related Peptide and Sympathetic Nervous System in Hypertension-Induced Renal Damage Hypertension, December 1, 2005; 46(6): e23 - e24. [Full Text] [PDF]

				X. J, L. G, W. P, V. H, Y. X, L. Y, W. Y, P. A, C. S, D. GV, et al. Kidney and Blood Pressure--The Story Unfolds: Renalase Is a Novel, Soluble Monoamine Oxidase That Regulates Cardiac Function and Blood Pressure. J Clin Invest J. Am. Soc. Nephrol., September 1, 2005; 16(9): 2521 - 2527. [Full Text] [PDF]

				K. Klein, M. Daschner, M. Vogel, J. Oh, T. J. Feuerstein, and F. Schaefer Impaired Autofeedback Regulation of Hypothalamic Norepinephrine Release in Experimental Uremia J. Am. Soc. Nephrol., July 1, 2005; 16(7): 2081 - 2087. [Abstract] [Full Text] [PDF]

				J. Neumann, G. Ligtenberg, L. Oey, H. A. Koomans, and P. J. Blankestijn Moxonidine Normalizes Sympathetic Hyperactivity in Patients with Eprosartan-Treated Chronic Renal Failure J. Am. Soc. Nephrol., November 1, 2004; 15(11): 2902 - 2907. [Abstract] [Full Text] [PDF]

				P. J. Blankestijn Sympathetic hyperactivity in chronic kidney disease Nephrol. Dial. Transplant., June 1, 2004; 19(6): 1354 - 1357. [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673