Download PDF
Interventionelle Radiologie Scan 2013; 01(01): 59-85
DOI: 10.1055/s-0032-1326471
Fortbildung
© Georg Thieme Verlag KG Stuttgart · New York

Renale Denervation

Dirk Blondin
,
Oliver Vonend
,
Sebastian A. Potthoff
Further Information

Publication History

Publication Date:
16 May 2013 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die katheterbasierte renale Denervation ist ein innovatives Verfahren, das eine neue Behandlungsoption bei therapierefraktärer Hypertonie darstellt. Auch wenn die Zahl der bisher behandelten Patienten noch nicht sehr groß ist, so sind die vorhandenen Daten vielversprechend. Dieser Artikel beschreibt die pathophysiologischen Hintergründe und Erklärungsansätze der Methode und fasst die aktuellen Studiendaten zusammen. Weiterhin werden die derzeit verfügbaren Systeme im Einzelnen vorgestellt und die praktische Umsetzung konkret beschrieben. Dabei werden alle zu berücksichtigenden Aspekte dargestellt und erläutert. Zuletzt werden die technischen Weiterentwicklungen und mögliche Ausweitungen der Indikation zur renalen Denervation diskutiert.

 

  • Literatur

  • 1 Lim SS, Vos T, Flaxman AD et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2224-2260
    CrossrefPubMedGoogle Scholar
  • 2 Meisinger C, Heier M, Völzke H et al. Regional disparities of hypertension prevalence and management within Germany. J Hypertens 2006; 24: 293-299
    CrossrefGoogle Scholar
  • 3 Weinehall L, Ohgren B, Persson M et al. High remaining risk in poorly treated hypertension: the ‚rule of halves‘ still exists. J Hypertens 2002; 20: 2081-2088
    CrossrefGoogle Scholar
  • 4 Mancia G, De Backer G, Dominiczak A et al. 2007 ESH-ESC Practice Guidelines for the Management of Arterial Hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension. J Hypertens 2007; 25: 1751-1762
    CrossrefGoogle Scholar
  • 5 Calhoun DA, Jones D, Textor S et al. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation 2008; 117: e510-e526
    CrossrefGoogle Scholar
  • 6 Smith PA, Graham LN, Mackintosh AF et al. Relationship between central sympathetic activity and stages of human hypertension. Am J Hypertens 2004; 17: 217-222
    CrossrefGoogle Scholar
  • 7 Bruening F. Die operative Behandlung des Halsbrustsympathikus und Bemerkungen ueber die operative Behandlung der abnormen Blutdrucksteigerung. Klin Wochenschr 1923; 2: 777-780
    CrossrefGoogle Scholar
  • 8 Smithwick RH, Thompson JE. Splanchnicectomy for essential hypertension; results in 1.266 cases. J Am Med Assoc 1953; 152: 1501-1504
    CrossrefGoogle Scholar
  • 9 Hart EC, Charkoudian N. Sympathetic neural mechanisms in human blood pressure regulation. Curr Hypertens Rep 2011; 13: 237-243
    CrossrefGoogle Scholar
  • 10 Vonend O, Rump LC, Ritz E. Sympathetic overactivity – the Cinderella of cardiovascular risk factors in dialysis patients. Semin Dial 2008; 21: 326-330
    CrossrefGoogle Scholar
  • 11 Vonend O, Okonek A, Stegbauer J et al. Renovascular effects of sympathetic cotransmitters ATP and NPY are age-dependent in spontaneously hypertensive rats. Cardiovasc Res 2005; 66: 345-352
    CrossrefGoogle Scholar
  • 12 Vonend O, Habbel S, Stegbauer J et al. Alpha(2A)-adrenoceptors regulate sympathetic transmitter release in mice kidneys. Br J Pharmacol 2007; 150: 121-127
    Google Scholar
  • 13 Vonend O, Oberhauser V, von Kügelgen I et al. ATP release in human kidney cortex and its mitogenic effects in visceral glomerular epithelial cells. Kidney Int 2002; 61: 1617-1626
    CrossrefGoogle Scholar
  • 14 Oberhauser V, Vonend O, Rump LC. Neuropeptide Y and ATP interact to control renovascular resistance in the rat. J Am Soc Nephrol 1999; 10: 1179-1185
    Google Scholar
  • 15 Carlson SH, Wyss JM. Neurohormonal regulation of the sympathetic nervous system: new insights into central mechanisms of action. Curr Hypertens Rep 2008; 10: 233-240
    CrossrefGoogle Scholar
  • 16 Campese VM. Neurogenic factors and hypertension in renal disease. Kidney Int Suppl 2000; 75: 2-6
    Google Scholar
  • 17 Converse Jr RL, Jacobsen TN, Toto RD et al. Sympathetic overactivity in patients with chronic renal failure. N Engl J Med 1992; 327: 1912-1918
    CrossrefGoogle Scholar
  • 18 Hausberg M, Kosch M, Harmelink P et al. Sympathetic nerve activity in end-stage renal disease. Circulation 2002; 106: 1974-1979
    CrossrefPubMedGoogle Scholar
  • 19 Floras JS. Sympathetic nervous system activation in human heart failure: clinical implications of an updated model. J Am Coll Cardiol 2009; 54: 375-385
    CrossrefGoogle Scholar
  • 20 Oda Y, Asanoi H, Ueno H et al. Pulse-synchronous sympathetic burst power as a new index of sympathoexcitation in patients with heart failure. Am J Physiol Heart Circ Physiol 2004; 287: H1821-H1827
    CrossrefGoogle Scholar
  • 21 Pedrosa RP, Drager LF, Gonzaga CC et al. Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension 2011; 58: 811-817
    CrossrefGoogle Scholar
  • 22 Silverberg DS, Oksenberg A, Iaina A. Sleep-related breathing disorders as a major cause of essential hypertension: fact or fiction?. Curr Opin Nephrol Hypertens 1998; 7: 353-357
    CrossrefGoogle Scholar
  • 23 Narkiewicz K, Somers VK. Sympathetic nerve activity in obstructive sleep apnoea. Acta Physiol Scand 2003; 177: 385-390
    CrossrefGoogle Scholar
  • 24 Witkowski A, Prejbisz A, Florczak E et al. Effects of renal sympathetic denervation on blood pressure, sleep apnea course, and glycemic control in patients with resistant hypertension and sleep apnea. Hypertension 2011; 58: 559-565
    CrossrefGoogle Scholar
  • 25 Page IH, Heuer GJ. The effect of renal denervation on patients suffering from nephritis. J Clin Invest 1935; 14: 443-458
    CrossrefGoogle Scholar
  • 26 Schlaich MP, Sobotka PA, Krum H et al. Renal sympathetic-nerve ablation for uncontrolled hypertension. N Engl J Med 2009; 361: 932-934
    CrossrefGoogle Scholar
  • 27 Krum H. Long-term follow-up of catheter-based renal sympathetic denervation for resistant hypertension confirms durable blood pressure reduction. ACC 2012, March 24–27, Chicago (USA)
    Google Scholar
  • 28 Symplicity HTN-2 Investigators. Catheter-based renal sympathetic denervation for resistant hypertension: durability of blood pressure reduction out to 24 months. Hypertension 2011; 57: 911-917
    CrossrefGoogle Scholar
  • 29 Esler MD, Krum H. Symplicity HTN-2 Investigators et al. Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial. Lancet 2010; 376: 1903-1909
    CrossrefGoogle Scholar
  • 30 Schmieder RE, Redon J, Grassi G et al. ESH position paper: renal denervation – an interventional therapy of resistant hypertension. J Hypertens 2012; 30: 837-841
    CrossrefGoogle Scholar
  • 31 Mahfoud F, Vonend O, Bruck H et al. Expert consensus statement on interventional renal sympathetic denervation for hypertension treatment. Dtsch Med Wochenschr 2011; 136: 2418
    Article in Thieme ConnectGoogle Scholar
  • 32 Vonend O, Antoch G, Rump LC et al. Secondary rise in blood pressure after renal denervation. Lancet 2012; 380: 778
    CrossrefGoogle Scholar
  • 33 Kandzari DE, Bhatt DL, Sobotka PA et al. Catheter-based renal denervation for resistant hypertension: rationale and design of the SYMPLICITY HTN-3 Trial. Clin Cardiol 2012; 35: 528-535
    CrossrefGoogle Scholar
  • 34 Ahmed H, Neuzil P, Skoda J et al. Renal sympathetic denervation using an irrigated radiofrequency ablation catheter for the management of drug-resistant hypertension. JACC Cardiovasc Interv 2012; 5: 758-765
    CrossrefGoogle Scholar
  • 35 Bunte MC, Infante de Oliveira E, Shishehbor MH. Endovascular treatment of resistant and uncontrolled hypertension: therapies on the horizon. JACC Cardiovasc Interv 2013; 6: 1-9
    CrossrefGoogle Scholar
  • 36 Pollak R, Prusak BF, Mozes MF. Anatomic abnormalities of cadaver kidneys procured for purposes of transplantation. Am Surg 1986; 52: 233-235
    Google Scholar
  • 37 Steigerwald K, Titova A, Malle C et al. Morphological assessment of renal arteries after radiofrequency catheter-based sympathetic denervation in a porcine model. J Hypertens 2012; 30: 2230-2239
    CrossrefGoogle Scholar
  • 38 Mahfoud F, Schlaich M, Kindermann I et al. Effect of renal sympathetic denervation on glucose metabolism in patients with resistant hypertension: a pilot study. Circulation 2011; 123: 1940-1946
    CrossrefGoogle Scholar
  • 39 Vink EE, de Jager RL, Blankestijn PJ. Sympathetic hyperactivity in chronic kidney disease: pathophysiology and (new) treatment options. Curr Hypertens Rep 2013; 15: 95-101
    CrossrefGoogle Scholar
  • 40 Sobotka PA, Krum H, Böhm M et al. The role of renal denervation in the treatment of heart failure. Curr Cardiol Rep 2012; 14: 285-292
    CrossrefGoogle Scholar
  • 41 Geisler BP, Egan BM, Cohen JT et al. Cost-effectiveness and clinical effectiveness of catheter-based renal denervation for resistant hypertension. J Am Coll Cardiol 2012; 60: 1271-1277
    CrossrefGoogle Scholar
  • 42 Hoppe UC et al. Minimally invasive system for baroreflex activation therapy chronically lowers blood pressure with pacemaker-like safety profile: results from the Barostim neo trial. J Am Soc Hypertens 2012; 6: 270-276
    CrossrefGoogle Scholar