Renal denervation in patients with resistant hypertension-beyond blood pressure reduction

Sa？etak Renal sympathetic denervation (RDN) has been demonstrated as an antihypertensive treatment in resistant hypertension patients, and triggers additional positive effects on glucose metabolism and insulin sensitivity in type 2 diabetes. The clinical implications of RDN in patients with type 2 diabetes, diabetic nephropathy and resistant hypertension have not yet been fully defined. We hypothesized that the small antihypertensive effects of RDN treatment will induce additional benefits on renal function in CKD patients with type 2 diabetes and resistant hypertension. We report the effects of RDN in two patients with type 2 diabetes, diabetic nephropathy, stage 3 chronic kidney disease and resistant hypertension. The blood pressure (BP) reduction after RDN was an 8-9% reduction of ABPM (sustained at consecutive follow-up visits at 3 and 6 months when compared to the baseline) and restoration of the night time dipping pattern was associated with amelioration of albuminuria (UAR). As proteinuria may accelerate kidney disease progression to end-stage renal failure, recognition of the antiproteinuric treatment is essential for providing renoprotection. Therefore, randomized clinical trials are required to assess the impact of reported changes