title: Major pathways of the reno-cardiovascular link: the sympathetic and renin-angiotensin systems.
abstract: Chronic kidney disease is often characterized by enhanced activity of the renin-angiotensin system (RAS) and the sympathetic nervous system. Independent of their effect on blood pressure, these systems also contribute to the pathogenesis of both structural and functional cardiovascular abnormalities and contribute importantly to clinical outcome. There is much evidence that the diseased kidneys are of central importance in the pathogenesis of both abnormalities. Inhibitors of the RAS also reduce sympathetic overactivity. Future research should be aimed at addressing the pathophysiological mechanisms causing the enhanced activities. Given the fact that even a small kidney lesion can cause enhanced activity of the RAS and the sympathetic nervous system, it is likely that these pathophysiological mechanisms are operational in more disease conditions, including essential hypertension, heart failure, and obesity/metabolic syndrome.
authors.affiliation: Department of Nephrology, University Medical Center , Utrecht, The Netherlands.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Blankestijn
authors.affiliation: INSERM U970, Hôpital Européen Georges Pompidou , Paris, France.
authors.forename: Gerard
authors.initials: G
authors.lastname: London
authors.affiliation: Department of Internal Medicine IV, Saarland University Medical Centre , Homburg/Saar, Germany.
authors.forename: Danilo
authors.initials: D
authors.lastname: Fliser
authors.affiliation: ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam , Amsterdam, The Netherlands.
authors.forename: Kitty J
authors.initials: KJ
authors.lastname: Jager
authors.affiliation: Department of Clinical Science, Intervention and Technology, Karolinska Institutet , Stockholm, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Lindholm
authors.affiliation: Renal Unit, Guy's and St Thomas' NHS Foundation Hospital, King's Health Partners , London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Goldsmith
authors.affiliation: Division of Internal Medicine and Nephrology, Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia , Katowice, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Wiecek
authors.affiliation: Nephrology Division, Department of Medicine, Akdeniz University Medical School , Antalya, Turkey.
authors.forename: Gultekin
authors.initials: G
authors.lastname: Suleymanlar
authors.affiliation: Indiana University and VAMC , Indianapolis, Indiana, USA.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Agarwal
authors.affiliation: Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo , Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Ortiz
authors.affiliation: INSERM ERI-12 (EA 4292), Amiens and Amiens University France , Amiens, France ; Amiens University Hospital and the Jules Verne University of Picardie , Amiens, France.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Massy
authors.affiliation: Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat , Barcelona, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Martinez-Castelao
authors.affiliation: Clinic of Nephrology, C.I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy , Iasi, Romania.
authors.forename: Adrian
authors.initials: A
authors.lastname: Covic
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Center , Leiden, The Netherlands.
authors.forename: Friedo W
authors.initials: FW
authors.lastname: Dekker
authors.affiliation: Nephrology, Dialysis and Transplantation Unit and CNR-IBIM Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension , Reggio Calabria, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
keywords: chronic kidney disease; hypertension; renin angiotensin; sympathetic activity