The gross anatomy of the renal sympathetic nerves revisited

Abstract

Catheter-based renal denervation techniques focus on reducing blood pressure in resistant hypertension. This procedure requires exact knowledge of the anatomical interrelation between the renal arteries and the targeted renal nervous plexus. The aim of this work was to build on classical anatomical studies and describe the gross anatomy and anatomical relationships of the renal arteries and nerve supply to the kidneys in a sample of human cadavers. Twelve human cadavers (six males and six females), age range 73 to 94 years, were dissected. The nervous fibers and renal arteries were dissected using a surgical microscope. The renal plexus along the hilar renal artery comprised a fiber-ganglionic ring surrounding the proximal third of the renal artery, a neural network along the middle and distal thirds, and smaller accessory ganglia along the course of the nerve fibers. The fibers of the neural network were mainly located on the superior (95.83%) and inferior (91.66%) surfaces of the renal artery and they were sparsely interconnected by diagonal fibers. Polar arteries were present in 33.33% of cases and the renal nerve pattern for these was similar to that of the hilar arteries. Effective renal denervation needs to target the superior and inferior surfaces of the hilar and polar arteries, where the fibers of the neural network are present. Clin. Anat. 29:660-664, 2016. © 2016 Wiley Periodicals, Inc.

R1 autonomic nervous system in acute kidney injury

“…The kidney receives a more abundant nerve supply than any other abdominal organ with the exception of the adrenal glands . The anatomy of renal sympathetic nerves in humans has been recently revisited, mostly confirming findings from previous anatomical studies . The renal plexus is composed of nerve fibres coming from the celiac ganglion, inferior and posterior renal ganglia, superior mesenteric ganglion and thoracic splanchnic nerves.…”

“…The renal plexus fibres run over the superior and inferior surfaces of the renal artery toward the renal hilum where they continue in the same orientation following the division of the hilar artery. All along their course, the main superior and inferior fibres are connected by thin twigs that run over the anterior and posterior surfaces of the renal arteries . In case of arterial variation, if more than one hilar artery is present, some nerves may cross the faces of the main renal artery to the accessory arteries.…”

“…In parallel, Okusa and colleagues uncovered that the previously described cholinergic anti‐inflammatory pathway is amenable to therapeutic intervention and has the potential to contribute additional strategies for limiting ischaemic AKI . Finally, failure of the Symplicity HTN‐3 study reinvigorated basic research focused on renal nerves and arteries …”

Predictive factors for successful renal denervation: should we use them in clinical trials?

“…Recent studies have also shown that innervation was more important in the medial and the distal part of the renal artery, where the number of sympathetic fibres is higher . Furthermore, contradictory results are found about the predominant repartition of the fibres around the artery in the different studies . Fibres are perhaps statistically less represented in the dorsal region, but this is important to remember they are disseminated all around the artery.…”

“…Importantly, anatomical and histological studies later demonstrated that nerves are closer to the lumen in the distal part of the renal arteries, and the renal artery divisions, where they are more readily reached by delivered energy . Recent studies have also shown that innervation was more important in the medial and the distal part of the renal artery, where the number of sympathetic fibres is higher .…”