© Springer International Publishing AG 2017 149
A. Covic et al. (eds.), Resistant Hypertension in Chronic Kidney Disease,
DOI 10.1007/978-3-319-56827-0_10
Chapter 10
Secondary Causes: Work-Up and Its
Specificities in CKD: Influence of Autonomic
Dysfunction
Radu Iliescu and Dragomir Nicolae Şerban
The Kidney, Pressure Natriuresis and Long-Term Control
of Blood Pressure
A thorough understanding of the mechanisms governing blood pressure regulation
over long term and the influence of the sympathetic nervous system upon these
mechanisms is necessary for the interpretation of clinical and experimental data
documenting the role of sympathetic activation in resistant hypertension and kidney
disease. While this and the following section provide only a brief overview, the
expert reader may choose to focus on the more specific sections “Sympathetic
Overactivation in Resistant Hypertension”, “Non-pharmacological Suppression of
Sympathetic Activity in Hypertension”, and “Aspects of Sympathetic Activation in
Resistant Hypertension Associated with CKD”
The relationship between renal perfusion pressure and the rate of sodium excre-
tion by the kidneys plays a major role in the regulation of blood pressure and body
fluid volume. If this relationship remains unchanged, any alteration in blood pres-
sure induced by changes in cardiac output and/or the resistance of peripheral vascu-
lature will lead to compensatory changes in renal sodium and water excretion and
consequently extracellular fluid volume, with eventual return of blood pressure to
normal levels. Therefore, any change in blood pressure would only be sustained
over long term if the renal pressure natriuresis mechanism is impaired. Indeed, all
forms of human or experimentally induced hypertension are associated with a reset-
ting of the pressure natriuresis mechanism to higher blood pressure levels. In other
R. Iliescu (*)
Department of Pharmacology, University of Medicine and Pharmacy “Gr. T. Popa” Iaşi,
Iaşi, Romania
e-mail: [email protected]; [email protected]
D.N. Şerban
Department of Physiology, University of Medicine and Pharmacy “Gr. T. Popa” Iaşi,
Iaşi, Romania