Hypertension in kidney transplantation is associated with an early renal nerve sprouting.

Abstract

BACKGROUND.:

Normalization of arterial pressure occurs in just a few patients with hypertensive chronic kidney disease undergoing kidney transplantation. Hypertension in kidney transplant recipients may be related to multiple factors. We aimed to assess whether hypertension in kidney-transplanted patients may be linked to reinnervation of renal arteries of the transplanted kidney.

METHODS.:

We investigated renal arteries innervation from native and transplanted kidneys in three patients 5 months, 2 years and 11 years after transplantation, respectively. Four transplanted kidneys from non-hypertensive patients on immunosuppressive treatment without evidence of hypertensive arteriolar damage were used as controls.

RESULTS:

. Evidence of nerve sprouting was observed as early as 5 months following transplantation, probably originated from ganglions of recipient patient located near the arterial anastomosis and was associated with mild hypertensive arteriolar damage. Regeneration of periadventitial nerves was already complete 2 years after transplantation. Nerve density tended to reach values observed in native kidney arteries and was associated with hypertension-related arteriolar lesions in transplanted kidneys. Control kidneys, albeit on an immunosuppressive regimen, presented only a modest regeneration of sympathetic nerves.

CONCLUSIONS:

. Our results suggest that the considerable increase in sympathetic nerves, as found in patients with severe arterial damage, may be correlated to hypertension rather than to immunosuppressive therapy, thus providing a morphological basis for hypertension recurrence despite renal denervation.

• Authors: Alessandro Mauriello, Valentina Rovella, Filippo Borri, Lucia Anemona, Elena Giannini, Erica Giacobbi, Andrea Saggini, Giampiero Palmieri, Alessandro Anselmo, Pierluigi Bove, Gerry Melino, Guardini Valentina, Manfredi Tesauro, D'Urso Gabriele, Nicola Di Daniele
• Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association (Nephrol Dial Transplant) Vol. 32 Issue 6 Pg. 1053-1060 (Jun 01 2017) ISSN: 1460-2385 [Electronic] England
• PMID: 28498963 (Publication Type: Journal Article)
• Copyright: © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA.

Topics

• Aged
• Blood Pressure (physiology)
• Female
• Humans
• Hypertension (mortality, physiopathology)
• Kidney (innervation, pathology)
• Kidney Failure, Chronic (mortality, physiopathology, surgery)
• Kidney Transplantation
• Male
• Nerve Regeneration
• Renal Artery (physiopathology)
• Sympathetic Nervous System (physiopathology)