Neural Control Of Renal Function Second Edition

The kidney is innervated with efferent sympathetic nerve fibers reaching the renal vasculature, the tubules, the juxtaglomerular granular cells, and the renal pelvic wall. The renal sensory nerves are mainly found in the renal pelvic wall. Increases in efferent renal sympathetic nerve activity reduce renal blood flow and urinary sodium excretion by activation of α1-adrenoceptors and increase renin secretion rate by activation of β1-adrenoceptors. In response to normal physiological stimulation, changes in efferent renal sympathetic nerve activity contribute importantly to homeostatic regulation of sodium and water balance. The renal mechanosensory nerves are activated by stretch of the renal pelvic tissue produced by increases in renal pelvic tissue of a magnitude that may occur during increased urine flow rate. Under normal conditions, the renal mechanosensory nerves activated by stretch of the sensory nerves elicits an inhibitory renorenal reflex response consisting of decreases in efferent renal sympathetic nerve activity leading to natriuresis. Increasing efferent sympathetic nerve activity increases afferent renal nerve activity which, in turn, decreases efferent renal sympathetic nerve activity by activation of the renorenal reflexes. Thus, activation of the afferent renal nerves buffers changes in efferent renal sympathetic nerve activity in the overall goal of maintaining sodium balance. In pathological conditions of sodium retention, impairment of the inhibitory renorenal reflexes contributes to an inappropriately increased efferent renal sympathetic nerve activity in the presence of sodium retention. In states of renal disease or injury, there is a shift from inhibitory to excitatory reflexes originating in the kidney. Studies in essential hypertensive patients have shown that renal denervation results in long-term reduction in arterial pressure, suggesting an important role for the efferent and afferent renal nerves in hypertension.

The kidney is innervated with efferent sympathetic nerve fibers reaching the renal vasculature, the tubules, the juxtaglomerular granular cells, and the renal pelvic wall. The renal sensory nerves are mainly found in the renal pelvic wall. Increases in efferent renal sympathetic nerve activity reduce renal blood flow and urinary sodium excretion by activation of α1-adrenoceptors and increase renin secretion rate by activation of β1-adrenoceptors. In response to normal physiological stimulation, changes in efferent renal sympathetic nerve activity contribute importantly to homeostatic regulation of sodium and water balance. The renal mechanosensory nerves are activated by stretch of the renal pelvic tissue produced by increases in renal pelvic pressure of a magnitude that may occur during increased urine flow rate. Activation of the sensory nerves elicits an inhibitory renorenal reflex response consisting of decreases in efferent renal sympathetic nerve activity leading to natriuresis. Increasing efferent sympathetic nerve activity increases afferent renal nerve activity which, in turn, decreases efferent renal sympathetic nerve activity by activation of the renorenal reflexes. Thus, activation of the afferent renal nerves buffers changes in efferent renal sympathetic nerve activity in the overall goal of maintaining sodium balance. In pathological conditions of sodium retention, impairment of the inhibitory renorenal reflexes contributes to an inappropriately increased efferent renal sympathetic nerve activity in the presence of sodium retention. In states of renal disease or injury, there is a shift from inhibitory to excitatory reflexes originating in the kidney. Studies in essential hypertensive patients have shown that renal denervation results in long-term reduction in arterial pressure, suggesting an important role for the efferent and afferent renal nerves in hypertension. Table of Contents: Part I: Efferent Renal Sympathetic Nerves / Introduction / Neuroanatomy / Neural Control of Renal Hemodynamics / Neural Control of Renal Tubular Function / Neural Control of Renin Secretion Rate / Part II: Afferent Renal Sensory Nerves / Introduction / Neuroanatomy / Renorenal Reflexes / Mechanisms Involved in the Activation of Afferent Renal Sensory Nerves / Part III: Pathophysiological States / Efferent Renal Sympathetic Nerves / Afferent Renal Sensory Nerves / Conclusions / References

Advances in Physiological Sciences, Volume 11: Kidney and Body Fluids offers a thorough discussion of the experiments, research, and investigations done on the function, composition, and chemical reactions the kidney and body fluids undergo. Divided into 10 parts and having 88 chapters, the book features lengthy literature of authors who have actively pursued research on kidney and body fluids. Areas covered include renal cell cultures and blood flow; glomerulotubular balance; cell ionic activity and element analysis; electrophysiology and epithelial transport; and tubular handling of phosphate and calcium. Tubular acidification, regulation of water balance, and extracellular volume control are also discussed. The text presents as well how the study of the kidney and body fluids have captured the interest of physiologists and other individuals interested in this discipline. The book is a dependable source of information for those interested in the composition, function, and chemical reactions of the kidney and body fluids. The text is highly recommended to scholars and students who find this field of study interesting.

Hypertension: from basic research to clinical practice” contains a unique collection of selected chapters written by experts and enthusiasts engaged in research and treatment of hypertension, a condition that affects around a billion people in the world. The chapters describe fundamental researches at cellular and molecular levels to the science, and art of treatment of the condition in clinical practice. The topics included ranges from pathophysiology of hypertension, through monitoring of hypertension, to the treatment of hypertension in different patient categories. It contains essential background information as well as cutting edge research, and state of the art treatment alternatives in this broad field. From the beginners, and research students to the expert clinicians, and established scientists, everybody has something to learn from this book.

The second edition of Paediatric Surgery has been designed to be highly relevant to the practice of clinical paediatric surgery. With this in mind, topics are presented in a clear and easily digestible format, with the most important learning points in each area clearly identified. The principles of the basic sciences, and how these relate to competent clinical practice, are covered in each clinical chapter, and are an important part of the Intercollegiate Board examination and other higher examinations in paediatric surgery in Europe and Australasia. While many of the topics from the previous edition have been retained and updated as appropriate, there are a number of important additions. The important and developing field of minimally invasive surgery has been given more prominence. Oncology has been expanded to include more detail on solid tumours as well as more on central venous access and the surgical assessment of the acutely unwell child undergoing chemotherapy. Thoracic surgery has been expanded to include the management of empyema and the open and endoscopic approach to resection and biopsy. Finally, important 'generic' issues such as communication skills, the critical analysis of journal articles and evidence-based medicine have all been introduced. The second edition of Paediatric Surgery will be an invaluable resource for all trainee paediatric surgeons, providing a summary of practical, evidence-based advice for the candidate for the Intercollegiate Board Speciality Examination in Paediatric Surgery (FRCS Paeds), or other equivalent examination, without overwhelming and unnecessary detail.

Sympathetic overactivity is associated with the development of hypertension. Renal denervation (RDN) prevents or delays hypertension in a variety of animal models, which laid the groundwork for the introduction of RDN as a clinical therapy in humans. In 2007, a novel, minimally invasive RDN ablation catheter was first trialled in hypertensive patients, with a 93% success rate of lowering blood pressure for at least three years post-RDN. However, a large scale, sham-controlled clinical trial (Symplicity HTN -3) failed to show reductions in BP greater than sham. The aim of this research topic was to evaluate the efficacy and safety of RDN, to explore the contribution of both afferent and efferent renal nerve activity to hypertension and non-hypertension disorders, and to stimulate future research to better understand the function of the renal nerves and the effects of RDN by highlighting gaps in knowledge.