The kidney has been shown to be critically involved as both trigger and target of sympathetic nervous system
overactivity in both experimental and clinical studies. Renal injury and ischemia, activation of renin angiotensin system
and dysfunction of nitric oxide system have been implicated in adrenergic activation from kidney. Conversely, several
lines of evidence suggest that sympathetic overactivity, through functional and morphological alterations in renal
physiology and structure, may contribute to kidney injury and chronic kidney disease progression. Pharmacologic
modulation of sympathetic nervous system activity has been found to have a blood pressure independent renoprotective
effect. The inadequate normalization of sympathoexcitation by pharmacologic treatment asks for novel treatment options.
Catheter based renal denervation targets selectively both efferent and afferent renal nerves and functionally denervates the
kidney providing blood pressure reduction in clinical trials and renoprotection in experimental models by ameliorating the
effects of excessive renal sympathetic drive. This review will focus on the role of sympathetic overactivity in the
pathogenesis of kidney injury and CKD progression and will speculate on the effect of renal denervation to these
Keywords: Chronic kidney disease renal ablation, resistant hypertension.
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