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Renal Sympathetic Afferent Nerves: Kidney as Origin of Central Sympathetic Drive

Renal Sympathetic Afferent Nerves: Kidney as Origin of Central Sympathetic Drive. Vasoconstriction Atherosclerosis. Hypertrophy Arrhythmia Oxygen Consumption. Sleep Disturbances. Renal Afferent Nerves. Insulin Resistance. ↑ Renin Release  RAAS activation ↑ Sodium Retention

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Renal Sympathetic Afferent Nerves: Kidney as Origin of Central Sympathetic Drive

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  1. Renal Sympathetic Afferent Nerves:Kidney as Origin of Central Sympathetic Drive Vasoconstriction Atherosclerosis Hypertrophy Arrhythmia Oxygen Consumption Sleep Disturbances Renal Afferent Nerves Insulin Resistance ↑ Renin Release  RAAS activation ↑ Sodium Retention ↓ Renal Blood Flow 1

  2. Renal Nerve Anatomy Allows a Catheter-Based Approach • Standard interventional technique • 4-6 two-minute treatments per artery • Proprietary RF Generator • Automated • Low-power • Built-in safety algorithms In the United States: Caution: Investigational Device. Limited by U.S. law to investigational use. 2

  3. Significant, Sustained BP Reduction BP change (mmHg) Sievert et al. European Society of Cardiology. 2010. 3

  4. Proof of Principle Central SympatheticNerve Activity Muscle Sympathetic Nerve Activity (MSNA) NorepinephrineSpillover Renal SympatheticNerve Activity 4

  5. Reduction of Renal Contribution to Central Sympathetic Drive: MSNA in Resistant Hypertension Patient * 59 year old male on 7 HTN meds Baseline 1 mo 12 mo * Improvement in cardiac baroreflex sensitivity after renal denervation (7.8 11.7 msec/mmHg) Schlaich et al. NEJM. 2009; 36(9): 932-934. 5

  6. Renal Norepinephrine Spillover: 10 cases • Mean total renal norepinephrine spillover ↓ 47%, p=0.023 (95% CI: 28–65%) • Mean total body NE spillover ↓ 28%, p=0.043 (95% CI: 4–52%) Example Case: Left: 75 % reduction Right: 85 % reduction Esler et al. J Htn. 2009;27(suppl 4):s167. Schlaich et al. J Htn. 2009;27(suppl 4):s154. 6

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