Abstract
This review examines the participation of immunocompetent cells that accumulate in tubulointerstitial areas of the kidney in the pathogenesis of sodium-sensitive hypertension. Tubulointerstitial inflammation is a universal feature in experimental models of sodium-sensitive hypertension, and the suppression of inflammation and its constant companions, oxidative stress and renal angiotensin II activity, ameliorates or prevents hypertension. Human studies also support the association between renal inflammation and hypertension. The proinflammatory effects of a high sodium diet and the mechanisms by which renal inflammation induces sodium retention are discussed. It is suggested that autoimmune reactivity may play a role in the development and maintenance of renal inflammation in hypertensive states.
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Cirillo M, Capasso G, Di Leo VA, De Santo NG. A history of salt. Am J Nephrol. 1994;14:426–31.
Hay JH. The significance of a raised blood pressure. Br Med J. 1931;2:43–7.
Moser M. Historical perspectives on the management of hypertension. J Clin Hypertens. 2006;8(8 Suppl 2):15–20.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of high blood pressure: the JNC 7 report. JAMA. 2003;289:2560–72.
Staessen JA, Wang J, Bianchi G, Birkenhäger WH. Essential hypertension. Lancet. 2003;361:1629–41.
Alderman MH. Dietary sodium and cardiovascular health in hypertensive patients—the case against universal sodium restriction. J Am Soc Nephrol. 2004;15(Suppl 1):S47–50.
He FJ, MacGregor GA. A comprehensive review of salt and health and current experience of worldwide salt reduction programmes. J Hum Hypertens. 2009;23:363–84.
Rodriguez-Iturbe B, Romero F, Johnson RJ. Pathophysiologic mechanisms of salt-dependent hypertension. Am J Kidney Dis. 2007;50:655–72.
Weinberger MH, Miller JZ, Luft FC, Grim CE, Fineberg NS. Definitions and characteristics of sodium sensitivity and blood pressure resistance. Hypertension. 1986;8(6 Part 2):II127–34.
Morimoto A, Uzu T, Fujii T, Nishimura M, Kuroda S, Nakamura S, et al. Sodium sensitivity and cardiovascular events in patients with essential hypertension. Lancet. 1997;350:1734–7.
Sullivan JM. Salt sensitivity. Definition, conception, methodology, and long-term issues. Hypertension. 1991;17(Suppl 1):161–8.
Weinberger MH, Fineberg NS, Fineberg SE, Weinberger M. Salt sensitivity, pulse pressure and death in normal and hypertensive humans. Hypertension. 2001;37(2 part 2):429–32.
Weinberg M, Fineberg N. Sodium and volume sensitivity of blood pressure. Age and pressure change over time. Hypertension. 1991;18:67–71.
Rodriguez-Iturbe B. The role of immunocompetent cell renal infiltration the pathogenesis of arterial hypertension. Nefrología. 2008;28:483–92.
Ruiz-Ortega M, Esteban V, Ruperez M, Sanchez-Lopez E, Rodriguez-Vita J, Carvajal G, et al. Renal and vascular hypertension-induced inflammation: role of angiotensin II. Curr Opin Nephrol Hypertens. 2006;15:159–66.
Bendich A, Belisle EH, Strausser HR. Immune system modulation and its effects on blood pressure of the spontaneously hypertensive male and female rat. Biochem Biophys Res Commun. 1981;99:600–7.
Khraibi AA, Norman RA Jr, Dzielak DJ. Chronic immunosuppression attenuates hypertension in Okamoto spontaneously hypertensive rats. Am J Physiol. 1984;247(16):H722–6.
Rodríguez-Iturbe B, Quiroz Y, Nava M, Bonet L, Chavez M, Herrera-Acosta J, et al. Reduction of renal immune cell infiltration results in blood pressure control in genetically hypertensive rats. Am J Physiol Renal Physiol. 2002;282:F191–201.
Rodríguez-Iturbe B, Zhan C-D, Quiroz Y, Sindhu RK, Vaziri ND. Antioxidant-rich diet improves hypertension and reduces renal immune infiltration in spontaneously hypertensive rats. Hypertension. 2003;41:341–6.
Nava M, Quiroz Y, Vaziri ND, Rodríguez-Iturbe B. Melatonin reduces renal interstitial inflammation and improves hypertension in spontaneously hypertensive rats. Am J Physiol Renal Physiol. 2003;284:F447–54.
Rodríguez-Iturbe B, Ferrebuz A, Vanegas V, Quiroz Y, Mezzano S, Vaziri ND. Early and sustained inhibition of nuclear factor kappa B prevents hypertension in spontaneously hypertensive rats. J Pharmacol Exp Ther. 2005;315:51–7.
Müller DN, Shagdarsuren E, Park JL, Dechend R, Mervaala E, Hampich F, et al. Immunosuppressive treatment protects against angiotensin-II induced renal damage. Am J Pathol. 2002;161:1679–93.
Mattson DL, James L, Berdan EA, Meister CJ. Immune suppression attenuates hypertension and renal disease in Dahl salt-hypertensive rats. Hypertension. 2006;48:149–56.
Tian N, Gu JW, Braddy SJ, Rose RA, Hughson MD, Manning RD Jr. Immune suppression prevents renal damage and dysfunction and reduces arterial pressure in salt-sensitive hypertension. Am J Physiol Heart Circ Physiol. 2007;292:H1018–25.
Bataillard P, Freiche J-C, Vincent M, Touraine J-L, Sassard JU. Effects of neonatal thymectomy on blood pressure and immunological characteristics of the genetically hypertensive rats of the Lyon strain. J Hypertens. 1986;4(Suppl 3):5455–67.
Svendsen JG. Spontaneous hypertension and hypertensive vascular disease in the NZB strain of mice. Acta Pathol Microbiol Scand (A). 1977;85(3):261–8.
Sela S, Mazor R, Amsalam M, Yagil C, Yagil Y, Kristal B. Primed polymorphonuclear leukocytes, oxidative stress and inflammation antecede hypertension in the Sabra rat. Hypertension. 2004;44:764–9.
Gianella A, Nobili E, Abbate M, Zoja C, Gelosa P, Mussoni L, et al. Rosuvastatin treatment prevents progressive kidney inflammation and fibrosis in stroke-prone rats. Am J Pathol. 2007;170:1165–77.
Rodriguez-Iturbe B, Sepassi L, Quiroz Y, Ni Z, Wallace DC, Vaziri ND. Association of mitochondrial SOD deficiency with salt-sensitive hypertension and accelerated renal senescence. J Appl Physiol. 2007;102:255–60.
Stewart T, Jung FF, Manning J, Vehaskari VM. Kidney immune cell infiltration and oxidative stress contribute to prenatally programmed hypertension. Kidney Int. 2005;68:2180–8.
Norman RA Jr, Galloway PG, Dzielak DJ, Huang M. Mechanisms of partial renal infarct hypertension. J Hypertens. 1988;6:397–403.
Hilgers KF, Hartner A, Porst M, Veelken R, Mann JFE. Angiotensin II type 1 receptor blockade prevents lethal malignant hypertension: relation to kidney inflammation. Circulation. 2001;104:1436–40.
Vanegas V, Ferrebuz A, Quiroz Y, Rodríguez-Iturbe B. Hypertension in page (cellophane wrapped) kidney is due to interstitial nephritis. Kidney Int. 2005;68:1161–70.
Bravo Y, Quiroz Y, Ferrebuz A, Vaziri ND, Rodríguez-Iturbe B. Mycophenolate mofetil administration reduces renal inflammation, oxidative stress and arterial pressure in rats with lead-induced hypertension. Am J Physiol Renal Physiol. 2007;297:F616–23.
Fujihara CK, Malheiros DM, Zatz R, Noronha IL. Mycophenolate mofetil attenuates renal injury in the rat remnant kidney. Kidney Int. 1998;54:1510–9.
Romero F, Rodríguez-Iturbe B, Parra G, González L, Herrera-Acosta J, Tapia E. Mycophenolate mofetil prevents the progressive renal failure induced by 5/6 renal ablation in rats. Kidney Int. 1999;55:945–55.
Remuzzi G, Zoja C, Gagliardini E, Corna D, Abbate M, Benigni A. Combining an antiproteinuric approach with mycophenolate mofetil fully suppresses progressive nephropathy of experimental animals. J Am Soc Nephrol. 1999;10:1542–9.
Svendsen JG. Spontaneous hypertension and hypertensive vascular disease in the NZB strain of mice. Acta Pathol Microbiol Scand (A). 1977;85:261–8.
Beswick RA, Zhang H, Marable D, Catravas JD, Hill WD, Webb RC. Long-term antioxidant administration attenuates mineralocorticoid hypertension and renal inflammatory response. Hypertension. 2001;37:781–6.
Ray PE, Suga S, Liu XH, Huang X, Johnson RJ. Chronic potassium depletion induces renal injury, salt sensitivity, and hypertension in young rats. Kidney Int. 2001;59:1850–8.
Suga S, Mazzali M, Ray PE, Kang DH, Johnson RJ. Angiotensin II type 1 receptor blockade ameliorates tubulointerstitial injury induced by chronic potassium deficiency. Kidney Int. 2002;61:951–8.
Rodríguez-Iturbe B, Pons H, Quiroz Y, Gordon K, Rincón J, Chávez M, et al. Mycophenolate mofetil prevents salt-sensitive hypertension resulting from angiotensin II exposure. Kidney Int. 2001;59:2222–32.
Lee DL, Sturgis LC, Labazi H, Osborne JB Jr, Fleming C, Pollock JS, et al. Angiotensin II hypertension in attenuated in interleukin-g knockout mice. Am J Physiol Heart Circ Physiol. 2006;290:H935–40.
Quiroz Y, Pons H, Gordon Kl, Rincón J, Chávez M, Parra G, et al. Mycophenolate mofetil prevents the salt-sensitive hypertension resulting from short-term nitric oxide síntesis inhibition. Am J Physiol Renal Physiol. 2002;281:F38–47.
Alvarez V, Quiroz Y, Nava M, Pons H, Rodríguez-Iturbe B. Overload proteinuria is followed by salt-sensitive hypertension caused by renal infiltration of immune cells. Am J Physiol Renal Physiol. 2002;283:F1132–41.
Rodriguez-Iturbe B, Quiroz Y, Kim CH, Vaziri ND. Hypertension induced by aortic coarctation above the renal arteries is associated with immune cell infiltration of the kidneys. Am J Hypertens. 2005;18:1449–56.
Johnson RJ, Gordon KL, Suga S, Duijvestijn AM, Griffin K, Bidani A. Renal injury in salt-sensitive hypertensionafter exposure to catecholamines. Hypertension. 1999;34:151–9.
Andoh TF, Johnson RJ, Lam T, Bennett WM. Subclinical renal injury induced by transient cyclosporine exposure is associated with salt-sensitive hypertension. Am J Transplant. 2001;1:222–7.
Herrera J, Ferrebuz A, MacGregor EG, Rodriguez-Iturbe B. Mycophenolate mofetil treatment improves hypertension in patients with psoriasis and rheumatoid arthritis. J Am Soc Nephrol. 2006;17(Suppl 3):S218–25.
Hughson MD, Gobe GC, Hoy WE, Manning RD Jr, Douglas-Denton R, Bertram JF. Associations of glomerular number and birth weight with clinicopathological features of African Americans and whites. Am J Kidney Dis. 2008;52:18–28.
Gu JW, Tian N, Shparago M, Tan W, Bailey AP, Manning RD Jr. Renal NF(kappa)B activation and TNF(alpha) up-regulation correlate with salt-sensitive hypertension in Dahl salt sensitive rats. Am J Physiol Regul Integr Comp Physiol. 2006;291:R1817–24.
Ying WZ, Sanders PW. Dietary salt modulates renal production of transforming growth factor-beta in rats. Am J Physiol Renal Physiol. 1998;4 Pt 274(2):F635–41.
Sanders PW. Salt intake, endothelial cell signaling, and progression of kidney disease. Hypertension. 2004;43:142–6.
Zacchigna L, Vecchione C, Notte A, Cordenonsi M, Dupont S, Maretto S, et al. Emilin1 links TGF-beta maturation to blood pressure homeostasis. Cell. 2006;124:2–929.
Kitiyakara C, Chabrashvili T, Chen Y, Blau J, Karber A, Aslam S, et al. Salt intake, oxidative stress and renal expression of NADPH oxidase and superoxide dismutase. J Am Soc Nephrol. 2003;14:2775–82.
Ni Z, Vaziri ND. Effect of salt loading on nitric oxide synthase expression in normotensive rats. Am J Hypertens. 2001;14:155–63.
Zewde T, Wu F, Mattson DL. Influence of dietary NaCl on l-arginine transport in the renal medulla. Am J Physiol Regul Integr Comp Physiol. 2004;286:R89–93.
Gu JW, Anand V, Shek EW, Moore MC, Brady AL, Kelly WC, et al. Sodium induces hypertrophy of cultured myocardial myoblasts and vascular smooth muscle cells. Hypertension. 1998;31:1083–7.
Thomson SC, Deng A, Wead L, Richter K, Blantz RC, Vallon V. An unexpected role for angiotensin II in the link between dietary salt and proximal reabsorption. J Clin Invest. 2006;116:1110–6.
Chandramohan G, Bai Y, Norris K, Rodriguez-Iturbe B, Vaziri ND. Effects of dietary salt on angiotensin system, NAD(P)oxidase, COX-2, MCP-1, PAI-1 abd NFkB in salt sensitive and salt resistant rat kidneys. Am J Nephrol. 2008;28:158–67.
Kobori H, Nangaku M, Navar LG, Nishiyama A. The intrarenal renin-angiotensin system: from physiology to the pathobiology of hypertension and kidney disease. Pharmacol Rev. 2007;59:251–87.
Kobori H, Alper AB Jr, Shenava R, Katsurada A, Saito T, Ohashi N, et al. Urinary angiotensinogen as a novel biomarker of the intrarenal renin-angiotensin system status in hypertensive patients. Hypertension. 2009;53:344–50.
Nishiyama A, Seth DM, Navar LG. Renal interstitial fluid concentrations of angiotensins I and II in anesthetized rats. Hypertension. 2002;39:129–34.
Franco M, Martínez F, Quiroz Y, Galicia O, Bautista R, Johnson RJ, et al. Renal angiotensin II concentration and interstitial infiltration of immune cells are correlated with blood pressure levels in salt-sensitive hypertension. Am J Physiol Regul Integr Comp Physiol. 2007;293:R251–6.
Pimenta E, Calhoun DA. Aldosterone, dietary salt and renal disease. Hypertension. 2006;48:209–10.
Nagase M, Matsui H, Shibata S, Gotoda T, Fujita T. Salt-induced nephropathy in obese spontaneously hypertensive rats via paradoxical activation of the mineralocorticoid receptor: role of oxidative stress. Hypertension. 2007;50:877–83.
Nagase M, Fujita T. Mineralocorticoid receptor activation in obesity and hypertension. Hypertens Res. 2009;32:649–57.
Shibata S, Nagase M, Yoshida S, Kawarazaki W, Kurihara W, Tanaka H, et al. Modification of the mineralocorticoid receptor function by Rac1 GTPase: implication in proteinuric kidney disease. Nat Med. 2008;14:1370–6.
Guyton AC, Coleman TG, Wilcox CS. Quantitative analysis of the pathophysiology of hypertension. J Am Soc Nephrol. 1969;10:2248–58.
Guyton AC. Blood pressure control: Special role of the kidney and body fluids. Science. 1991;252:1813–6.
Johnson RJ, Schreiner GF. Hypothesis: the role of acquired tubulointerstitial disease in the pathogenesis of salt-dependent hypertension. Kidney Int. 1997;52:1169–79.
Johnson RJ, Herrera J, Schreiner G, Rodríguez-Iturbe B. Acquired and subtle renal injury as a mechanism for salt-sensitive hypertension: bridging the hypothesis of Goldblatt and Guyton. N Engl J Med. 2002;346:913–23.
Rodriguez-Iturbe B, Johnson RJ. The role inflammatory cells in the kidney in the induction and maintenance of hypertension. Nephrol Dial Transplant. 2006;1:260–3.
Rodriguez-Iturbe B, Vaziri ND. Salt sensitive hypertension: update on novel findings. Nephrol Dial Transplant. 2007;22:992–5.
Wilcox CS. Oxidative stress and nitric oxide deficiency in the kidney: a critical link to hypertension? Am J Physiol Regul Integr Comp Physiol. 2005;289:R913–35.
Johnson RJ, Feig DI, Nakagawa T, Sanchez-Lozada LG, Rodriguez-Iturbe B. Pathogenesis of essential hypertension: historical paradigms and modern insights. J Hypertens. 2008;26:381–91.
Makino A, Skelton MM, Zou AP, Roman RJ, Cowley AW Jr. Increased renal medullary oxidative stress produces hypertension. Hypertension. 2002;39:667–72.
Cowley AW. Renal medullary oxidative stress, pressure-natriuresis and hypertension. Hypertension. 2008;52:777–86.
Guzik TJ, Hoch NE, Brown KA, McCann LA, Rahman A, Dikalov S, et al. Role of the T cell in the genesis of angiotensin II induced hypertension and vascular dysfunction. J Exp Med. 2007;204:2449–60.
Hoch NE, Guzik TJ, Chen W, Deans T, Maalouf SA, Gratze P, et al. Regulation of T-cell function by endogenously produced angiotensin II. Am J Physiol Regul Integr Comp Physiol. 2009;296:R208–16.
Vaziri ND, Rodriguez-Iturbe B. Mechanisms of disease: oxidative stress and inflammation in the pathogenesis of hypertension. Nat Clin Prac Nephrol. 2006;2:582–93.
Rodriguez-Iturbe B, Vaziri ND, Herrera-Acosta J, Johnson RJ. Oxidative stress, renal infiltration of immune cells and salt-sensitive hypertension: all for one and one for all. Am J Physiol Renal Physiol. 2004;286:F606–16.
Kaufmann SHE. Heat shock proteins and the immune response. Immunol Today. 1990;11:129–36.
Young RA. Stress proteins and immunology. Ann Rev Immunol. 1990;8:401–20.
Xu Q, Li DG, Holbrook NJ, Udelsman R. Acute hypertension induces heat-shock protein 70 gene expression in rat aorta. Circulation. 1995;92:1223–9.
Blake MJ, Klevay LM, Halas ES, Bode AM. Blood pressure and heat shock protein expression in response to acute and chronic stress. Hypertension. 1995;25(4 Pt 1):539–44.
Chang J, Wasser JS, Cornelussen RN, Knowlton AA. Activation of heat-shock factor by stretch-activated channels in rat hearts. Circulation. 2001;104:209–14.
Hamet P, Malo D, Hashimoto T, Tremblay J. Heat stress genes in hypertension. J Hypertens Suppl. 1990;8:S47–52.
Lodwick D, Kaiser MA, Harris J, Privat P, Vincent M, Sassard J, et al. Failure of the heat-shock protein 70 locus to cosegregate with blood pressure in spontaneously hypertensive rat × Wistar-Kyoto rat cross. J Hypertens. 1993;11:1047–51.
Li J-X, Tang B-P, Sun H-P, Feng M, Cheng Z-H, Niu W-Q. Interacting contribution of the five polymorphisms in three genes of Hsp70 family to essential hypertension in Uygur ethnicity. Cell Stress Chaperones. 2009;14:355–62.
Ishizaka N, Aizawa T, Ohno M, Usui Si S, Mori I, Tang SS, et al. Regulation and localization of HSP70 and HSP25 in the kidney of rats undergoing long-term administration of angiotensin II. Hypertension. 2002;39:122–8.
Bravo J, Quiroz Y, Pons H, Parra G, Herrera-Acosta J, Johnson RJ, et al. Vimentin and heat shock protein expression are induced in the kidney by angiotensin and by nitric oxide inhibition. Kidney Int. 2003;64(suppl 86):S46–51.
Parra G, Quiroz Y, Salazar J, Bravo Y, Pons H, Chavez M, et al. Experimental induction of salt-sensitive hypertension is associated with lymphocyte proliferative response to HSP70. Kidney Int Suppl. 2008;Suppl 111:S55–9.
House SD, Guidon PT Jr, Perdrizet GA, Rewinski M, Kyriakos R, Bockman RS, et al. Effects of heat shock, stannous chloride, and gallium nitrate on the rat inflammatory response. Cell Stress Chaperones. 2001;6:164–71.
van Eden W, Koets A, van Kooten P, Prakken B, van der Zee R. Immunopotentiating heat shock proteins: negotiators between innate danger and control of autoimmunity. Vaccine. 2003;21:897–901.
Alvarez V, Nava M, Quiroz Y, Chavez M, Herrera-Acosta J, Johnson RJ, Rodríguez-Iturbe B. Hyperuricemia induces salt sensitive hypertension (SSHTA) that may be prevented by reduction of tubulointerstitial inflammatory infiltrate. J Am Soc Nephrol. 2002;13:328A (abstract).
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Rodriguez-Iturbe, B. Renal infiltration of immunocompetent cells: cause and effect of sodium-sensitive hypertension. Clin Exp Nephrol 14, 105–111 (2010). https://doi.org/10.1007/s10157-010-0268-1
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DOI: https://doi.org/10.1007/s10157-010-0268-1