Proteinuria and renal function in hypertension: a role for the renal nerves

Proteinuria is a key marker of renal damage and is often associated with hypertension and increased cardiovascular risk. This study reviews and brings the potential involvement of renal nerves in the pathophysiology of proteinuria and renal impairment in clinical and experimental studies. Studies have highlighted that increased activation of renal sympathetic and sensory nerves activity either alone or in combination with the renin-angiotensin-aldosterone system (RAAS) contributes to the development of proteinuria and the decline in renal function. This phenomenon may occur through mechanisms that alter glomerular and/or tubular function. Additionally, interventions aimed at disrupting renal nerve activity, including pharmacological agents and surgical denervation, or RAAS blockade demonstrated a significant reduction in proteinuria and improved renal and cardiovascular outcomes. Here, we highlight the potential roles of renal nerves beyond their traditional effects on renal function, such as albumin reabsorption, glomerular function, and renal damage, in the onset and maintenance of cardiovascular disease and hypertensive nephropathy.