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Nephrol Dial Transplant. 2017 Jun 1;32(6):1053-1060. doi: 10.1093/ndt/gfx069.

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

Author information

1
Anatomic Pathology, Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy.
2
Hypertension and Nephrology Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy.
3
Transplantation Surgery, Department of Surgery Policlinico Tor Vergata Foundation, Rome, Italy.
4
Urology, Department of Experimental Medicine and Surgery, Rome, Italy.
5
Biochemistry, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy.

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.

KEYWORDS:

hypertension; kidney transplantation; nerve sprouting; sympathetic renal innervation

PMID:
28498963
PMCID:
PMC5837349
DOI:
10.1093/ndt/gfx069
[Indexed for MEDLINE]
Free PMC Article

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