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Sympathische Überaktivität und Niere

Sympathetic overactivity and the kidney

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Summary

Hypertension is present in the majority of patients with chronic renal failure and constitutes a major risk factor for the very high cardiovascular morbidity and mortality in this patient population. Furthermore hypertension is known to be a substantial progression factor in renal disease. In the past, it had been presumed that hypertension in chronic renal failure is due to enhanced sodium retention, chronic hypervolemia and increased activity of the renin-angiotensin-aldosteronesystem. Recent studies now provide evidence that sympathetic overactivity plays an additional important role and also promotes progression of renal failure. The treatment goal in renal patients is to delay or even prevent progression of renal failure and to reduce the cardiovascular risk. Recent studies have investigated the respective impact of sympatholytic drugs, e.g. inhibitors of the renin-angiotensin-aldosterone-system, β-blockers or l1-Imidazolin-receptor-agonists in fulfilling these aims. The present report will review experimental and clinical studies on the role of sympathetic overactivity in hypertension and chronic renal failure and possible new therapeutic options.

Zusammenfassung

Eine arterielle Hypertonie gilt als wesentlicher Progressionsfaktor für den renalen Funktionsverlust bei Patienten mit chronischer Niereninsuffizienz. Sie stellt in der Mehrzahl der Patienten auch einen Hauptrisikofaktor für die besonders hohe kardiovaskuläre Morbidität und Mortalität dar. Ursprünglich wurde die arterielle Hypertonie bei Patienten mit Niereninsuffizienz durch eine gesteigerte Salzretention, chronische Hypervolämie und erhöhte Aktivität des Renin-Angiotensin-Aldosteron-System erklärt. Neuere Studien zeigen, dass auch eine sympathische Überaktivität zur Bluthochdruckerhöhung bei chronischer Niereninsuffizienz und auch direkt zur Progression des renalen Schadens beiträgt. Studien der letzten Jahre untersuchten die Wirksamkeit sympatholytischer Substanzen, wie z.B. von Hemmern des Renin-Angiotensin-Aldosteron-Systems, β-Blockern oder zentralwirksamer l1-Imidazolinrezeptor-Agonisten, die die Progression der Nierenerkrankung verhindern oder zumindest verzögern und das kardiovaskuläre Risiko verringern können. Die vorliegende Arbeit soll einen Überblick über die experimentellen und klinischen Studien zur Rolle des Sympathikus bei Hypertonie und Niereninsuffizienz geben und mögliche neue Therapiestrategien aufzeigen.

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  1. Klinische Abteilung für Nephrologie und Dialyse, Universitätsklinik für Innere Medizin III, Allgemeines Krankenhaus der Stadt Wien, Währinger Gürtel 18-20, A-1090, Wien, Österreich

    Antje Habicht & Bruno Watschinger

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Habicht, A., Watschinger, B. Sympathische Überaktivität und Niere. Wien Klin Wochenschr 115, 634–640 (2003). https://doi.org/10.1007/BF03040468

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