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Hypertension
Renal nerve ablation
  1. Luca Donazzan,
  2. Felix Mahfoud,
  3. Stephan H Schirmer,
  4. Michael Böhm
  1. Klinik für Innere Medizin III (Kardiologie, Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
  1. Correspondence to Professor Michael Böhm, Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 1, Geb. 40, Homburg/Saar D-66421, Germany; Michael.Boehm{at}uks.eu

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Learning objectives

  • Correct patient selection for renal denervation is of paramount importance to get the best from the procedure. Readers should be able to identify the ideal candidate after reading the article.

  • Beyond pressure lowering effects, renal denervation demonstrated its efficacy in other conditions characterized by increased sympathetic activity. Readers should be able to know the pathophysiologic way of action of renal denervation and recognize its pleiotropic effects.

  • Despite large randomized studies have been conducted on renal denervation, the compilation of registries is important to monitor the efficacy and safety of the procedure in the daily practice. Readers should be able to collect the data to write a renal denervation registry after reading the article.

Curriculum topic: Hypertension

Five years have passed since the first study on percutaneous renal denervation (RDN) to treat resistant hypertension was published.1 During its short life this technique has demonstrated its safety and efficacy in reducing blood pressure (BP), and also its appreciable indirect effects on cardiovascular remodelling and pleiotropic effects on other pathologies characterised by high sympathetic activity. Some questions about renal nerve distribution, predictors of BP response, and indices of effective denervation still remain unanswered. Moreover, the results of the Symplicity HTN-3 study are in contrast with previous findings and have raised many questions. Over time, new devices have been developed that permit a faster and more complete ablation.

Renal nerve anatomy

Sympathetic fibres to the kidneys descend the spinal cord from the brain until they reach the lower thoracic and upper lumbar spinal nerves. Fibres then pass to the adjacent ganglia in the sympathetic trunks, continuing in the postganglionic fibres which form a circumferential ‘basket-weave plexus’w1 in the adventitia of the renal artery (RA). Afferent fibres from the kidneys follow similar routes in the reverse direction.

There is still debate regarding the location and distribution of renal nerves …

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