Microdissection of the Human Renal Nervous System. Implications for Performing Renal Denervation Procedures

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dc.contributor.authorGarcía Touchard, Arturo
dc.contributor.authorMaranillo Alcaide, Eva
dc.contributor.authorMompeo, Blanca
dc.contributor.authorSañudo Tejero, José Ramón
dc.date.accessioned2024-01-08T08:18:15Z
dc.date.available2024-01-08T08:18:15Z
dc.date.issued2020-03-20
dc.descriptionEl artículo ha sido comentado muy positivamente en "Persu A, Maes F, Renkin J, Pathak A. Renal Denervation in Hypertensive Patients: Back to Anatomy? Hypertension. 2020 Oct;76(4):1084-1086. doi: 10.1161/HYPERTENSIONAHA.120.15834. Epub 2020 Sep 9. PMID: 32903105; PMCID: PMC7480938."
dc.description.abstractDespite the use of renal denervation to treat hypertension, the anatomy of the renal nervous system remains poorly understood. We performed a detailed quantitative analysis of the human renal nervous system anatomy with the goal of optimizing renal denervation procedural safety and efficacy. Sixty kidneys from 30 human cadavers were systematically microdissected to quantify anatomic variations in renal nerve patterns. Contrary to current clinical perception, not all renal innervation followed the main renal artery. A significant portion of the renal nerves (late arriving nerves) frequently reached the kidney (73% of the right kidney and 53% of the left kidney) bypassing the main renal artery. The ratio of the main renal artery length/aorta-renal hilar distance proved to be a useful variable to identify the presence/absence of these late arriving nerves (odds ratio, 0.001 (95% CI, 0.00002–0.0692; P: 0.001) with a cutoff of 0.75 (sensitivity: 0.68, specificity: 0.83, area under ROC curve at threshold: 0.76). When present, polar arteries were also highly associated with the presence of late arriving nerve. Finally, the perivascular space around the proximal main renal artery was frequently occupied by fused ganglia from the solar plexus (right kidney: 53%, left kidney: 83%) and/or by the lumbar sympathetic chain (right kidney: 63%, left kidney: 60%). Both carried innervation to the kidneys but importantly also to other abdominal and pelvic organs, which can be accidentally denervated if the proximal renal artery is targeted for ablation. These novel anatomic insights may help guide future procedural treatment recommendations to increase the likelihood of safely reaching and destroying targeted nerves during renal denervation procedures.
dc.description.departmentDepto. de Anatomía y Embriología
dc.description.facultyFac. de Medicina
dc.description.refereedTRUE
dc.description.sponsorshipMedtronic
dc.description.statuspub
dc.identifier.citationGarcía-Touchard A, Maranillo E, Mompeo B, Sañudo JR. Microdissection of the Human Renal Nervous System: Implications for Performing Renal Denervation Procedures. Hypertension. 2020 Oct;76(4):1240-1246. doi: 10.1161/HYPERTENSIONAHA.120.15106. Epub 2020 Aug 24. PMID: 32829660.
dc.identifier.doi10.1161/HYPERTENSIONAHA.120.15106.
dc.identifier.essn1524-4563
dc.identifier.issn0194-911X
dc.identifier.officialurlhttp://hyper.ahajournals.org/
dc.identifier.pmid32829660
dc.identifier.relatedurlhttps://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=n&CSC=Y&PAGE=toc&D=yrovft&AN=00004268-000000000-00000
dc.identifier.relatedurlhttps://www.ahajournals.org/doi/epub/10.1161/HYPERTENSIONAHA.120.15106
dc.identifier.urihttps://hdl.handle.net/20.500.14352/91769
dc.issue.number4
dc.journal.titleHypertension
dc.language.isoeng
dc.page.final1246
dc.page.initial1240
dc.publisherAmerican Heart Association / Lippincott, Williams & Wilkins
dc.rights.accessRightsopen access
dc.subject.keywordDenervation
dc.subject.keywordHypertension
dc.subject.keywordKidney
dc.subject.keywordNervous system
dc.subject.keywordRenal artery
dc.subject.ucmCiencias Biomédicas
dc.subject.unesco2410.02 Anatomía Humana
dc.subject.unesco3213.17 Cirugía Vascular
dc.subject.unesco3205.01 Cardiología
dc.subject.unesco3205.06 Nefrología
dc.subject.unesco3213.14 Cirugía de Los Trasplantes
dc.titleMicrodissection of the Human Renal Nervous System. Implications for Performing Renal Denervation Procedures
dc.typejournal article
dc.type.hasVersionVoR
dc.volume.number76
dspace.entity.typePublication
relation.isAuthorOfPublicationc205208c-cdd9-4b73-ab05-35ee28af173f
relation.isAuthorOfPublicationdcb63eb9-b997-4f0a-a8f3-5f8b72d9ea08
relation.isAuthorOfPublication.latestForDiscoveryc205208c-cdd9-4b73-ab05-35ee28af173f
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