Sympathetic efferent renal nerves have key roles in the regulation of kidney function and blood pressure. Increased renal sympathetic nerve activity is thought to contribute to hypertension by promoting renal sodium retention, renin release and renal vasoconstriction. This hypothesis led to the development of catheter-based renal denervation (RDN) for the treatment of hypertension. Two RDN devices that ablate both efferent and afferent renal nerves received FDA approval for this indication in 2023. However, in animal models, selective ablation of afferent renal nerves resulted in comparable anti-hypertensive effects to ablation of efferent and afferent renal nerves and was associated with a reduction in sympathetic nerve activity. Selective afferent RDN also improved kidney function in a chronic kidney disease model. Notably, the beneficial effects of RDN extend beyond hypertension and chronic kidney disease to other clinical conditions that are associated with elevated sympathetic nerve activity, including heart failure and arrhythmia. These findings suggest that the kidney is an interoceptive organ, as increased renal sensory nerve activity modulates sympathetic activity to other organs. Future studies are needed to translate this knowledge into novel therapies for the treatment of hypertension and other cardiorenal diseases.

交感传出肾神经在肾功能和血压的调节中起关键作用。肾交感神经活动增加被认为通过促进肾钠潴留、肾素释放和肾血管收缩而导致高血压。这一假设导致了基于导管的肾去神经支配 （RDN） 治疗高血压的发展。两种消融传出和传入肾神经的 RDN 设备于 2023 年获得 FDA 批准用于该适应症。然而，在动物模型中，传入神经的选择性消融导致与传出和传入肾神经消融相当的抗高血压效果，并且与交感神经活动的减少有关。选择性传入 RDN 还改善了慢性肾病模型中的肾功能。值得注意的是，RDN 的有益影响不仅限于高血压和慢性肾病，还延伸到与交感神经活动升高相关的其他临床状况，包括心力衰竭和心律失常。这些发现表明肾脏是一个内感受器官，因为肾脏感觉神经活动的增加会调节对其他器官的交感神经活动。需要未来的研究将这些知识转化为治疗高血压和其他心肾疾病的新疗法。