Sympathetic nerve activity is inappropriately increased in chronic renal disease
Sympathetic nerve activity is inappropriately increased in chronic renal disease
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DOI：
10.1097/01.asn.0000098687.01005.a5
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发表时间：
2003-12-01
影响因子：
13.6
通讯作者：
Blankestijn, PJ
中科院分区：
文献类型：
--
作者：
Klein, IHHT;Ligtenberg, G;Blankestijn, PJ
提出了这样一种假设，即在患有肾实质疾病的高血压患者中，交感神经活性“不适当地”升高，这种过度活动是肾脏疾病的一个特征，而不是肾单位数量本身的减少。57例肾病患者(各种原因，无糖尿病，均服用降压药)，年龄18~62岁，肌酐清除量10~114ml/min/1.73m(2)。停用了抗高血压药物，但允许使用利尿剂，以防止过度水合。对匹配的对照组受试者也进行了研究。对7名患者停用利尿剂时和停药后体液状态变化的影响进行了检测，并对8名对照受试者在低钠饮食和高钠饮食时的体液状态变化进行了检测。对7名肾供者进行了单侧肾切除前后的研究。将腓神经的交感神经活动(MSNA)量化为肌交感神经活动。平均动脉压、MSNA和血浆肾素活性均高于对照组(分别为115+/-12和88+/-11毫米汞柱，31+/-15和18+/-10次/分钟，以及500[20~6940]和220[40~980]fmol/L/S；P<；0.01)。细胞外液容量(溴化物分布)无差异。7例患者停用利尿剂后再次进行研究。MSNA由34+/-18次/分降至19 18次/分(P<；0.01)。对8名健康受试者在低钠和高钠饮食期间进行了研究。MSNA分别为26+/-12和13+/-7次/分(P<；0.01)。细胞外液容量与MSNA的关系曲线在两组中平行，但在患者中向更高的MSNA水平移动。在肾捐献者中，肌酐清除量降低了25%，但MSNA在捐献前后没有变化。结论：在高血压合并肾实质疾病患者中，交感神经活性相对于体积状态是不适当的，肾单位数量的减少本身并不影响交感神经活性。
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.