Bilateral renal denervation prevents the development of hypertension during diet-induced obesity in male rats

Mechanisms involved in cardiovascular and hydroelectrolytic changes in dehydrated high-fat-diet-fed rats

Obesity is increasingly prevalent worldwide, and climate change is exacerbating water shortages, leading to dehydration. Both obesity and dehydration cause increased arterial pressure (AP), fluid electrolytic imbalance, and neuroinflammation. Thus, the present study aimed to verify the changes in the cardiovascular system, hydroelectrolytic balance, and microglia and neuronal activation in rats fed with a high-fat diet (HFD) in response to 24 h of water deprivation (WD) and the possible mechanisms involved. Male Holtzman rats (290-310 g) were fed with a standard diet (SD, 10% calories from fat) or HFD (46% calories from fat) for 6 wk before the WD experiments. Compared with WD SD rats, WD HFD rats presented a greater c-Fos immunolabeling in the subfornical organ (SFO) and supraoptic nucleus and greater microglial activation in SFO. WD-induced water intake was lower in HFD rats than in SD rats. WD HFD rats presented greater antidiuresis and lesser natriuresis than WD SD rats. Renal denervation did not change the antidiuresis or natriuresis observed in WD HFD- or SD-fed rats. The lower water intake in WD HFD rats might be due to neuroinflammation and/or decreased urinary output. The increase in AP after WD was similar between HFD and SD, but it is more dependent on angiotensin II type 1 (AT1) receptor activation in HFD rats. Overall, HFD rats seem less responsive to fluid and electrolyte balance responses to WD, highlighting the need for strategies to prevent dehydration in individuals with obesity, particularly during rising drought conditions worldwide.NEW & NOTEWORTHY Obesity and dehydration are common worldwide. Our study with an animal model found that changes in arterial pressure are linked to increased activation of the AT1 receptor in obese, dehydrated rats. The renal nerves appear unrelated to the significant decrease in urinary volume and sodium excretion in these animals. Neuroinflammation and reduced urine output may explain their lower water intake. These findings highlight the need for strategies to prevent dehydration in individuals with obesity.

Transmission of high arterial pressure into renal microvessels during venous-clamping augments ischaemia/reperfusion-induced acute kidney injury in anaesthetized rats

AIM

In two recent studies, we observed that a 30-min renal vein clamping caused formation of interstitial haemorrhagic congestion in ischaemic and ischaemic/reperfused kidney along with the development of severer acute kidney injury (AKI) than renal artery or pedicle clamping. It was suggested that the transmission of high arterial pressure into renal microvessels during vein occlusion probably causes the occurrence of interstitial haemorrhagic congestion that augments AKI. The present investigation aimed to evaluate this suggestion by reducing renal perfusion pressure (RPP) during renal venous occlusion.

METHODS

Anaesthetized male Sprague-Dawley rats were divided into three groups (n = 8), which underwent a 2-h reperfusion period following 30-min bilateral renal venous clamping along with reduced RPP (VIR-rRPP group) or without reduced RPP (VIR group) and an equivalent period after sham-operation (Sham group).

RESULTS

The VIR-rRPP group compared with VIR group had lower levels of kidney malondialdehyde and tissue damages as epithelial injuries of proximal tubule and thick ascending limb, vascular congestion, intratubular cast and oedema, along with the less reductions in renal blood flow, creatinine clearance, Na+ -reabsorption, K+ and urea excretion, urine osmolality and free-water reabsorption. Importantly, the formation of intensive interstitial haemorrhagic congestion in the VIR group was not observed in the VIR-rRPP group.

CONCLUSION

These results indicate that the transmission of high arterial pressure into renal microvessels during venous occlusion leads to rupturing of their walls and the formation of interstitial haemorrhagic congestion, which has an augmenting impact on ischaemia/reperfusion-induced renal structural damages and haemodynamic, excretory and urine-concentrating dysfunctions.

Mechanisms and treatment of obesity-related hypertension-Part 1: Mechanisms

The prevalence of obesity has tripled over the past five decades. Obesity, especially visceral obesity, is closely related to hypertension, increasing the risk of primary (essential) hypertension by 65%-75%. Hypertension is a major risk factor for cardiovascular disease, the leading cause of death worldwide, and its prevalence is rapidly increasing following the pandemic rise in obesity. Although the causal relationship between obesity and high blood pressure (BP) is well established, the detailed mechanisms for such association are still under research. For more than 30 years sympathetic nervous system (SNS) and kidney sodium reabsorption activation, secondary to insulin resistance and compensatory hyperinsulinemia, have been considered as primary mediators of elevated BP in obesity. However, experimental and clinical data show that severe insulin resistance and hyperinsulinemia can occur in the absence of elevated BP, challenging the causal relationship between insulin resistance and hyperinsulinemia as the key factor linking obesity to hypertension. The purpose of Part 1 of this review is to summarize the available data on recently emerging mechanisms believed to contribute to obesity-related hypertension through increased sodium reabsorption and volume expansion, such as: physical compression of the kidney by perirenal/intrarenal fat and overactivation of the systemic/renal SNS and the renin-angiotensin-aldosterone system. The role of hyperleptinemia, impaired chemoreceptor and baroreceptor reflexes, and increased perivascular fat is also discussed. Specifically targeting these mechanisms may pave the way for a new therapeutic intervention in the treatment of obesity-related hypertension in the context of 'precision medicine' principles, which will be discussed in Part 2.

Possible organ-protective effects of renal denervation: insights from basic studies

Inappropriate sympathetic nervous activation is the body's response to biological stress and is thought to be involved in the development of various lifestyle-related diseases through an elevation in blood pressure. Experimental studies have shown that surgical renal denervation decreases blood pressure in hypertensive animals. Recently, minimally invasive catheter-based renal denervation has been clinically developed, which results in a reduction in blood pressure in patients with resistant hypertension. Accumulating evidence in basic studies has shown that renal denervation exerts beneficial effects on cardiovascular disease and chronic kidney disease. Interestingly, recent studies have also indicated that renal denervation improves glucose tolerance and inflammatory changes. In this review article, we summarize the evidence from animal studies to provide comprehensive insight into the organ-protective effects of renal denervation beyond changes in blood pressure.