The kidney is innervated with efferent sympathetic nerve fibers reaching the renal vasculature, the tubules, the juxtaglomerular granular cells, and the renal pelvic wall. The renal sensory nerves are mainly found in the renal pelvic wall. Increases in efferent renal sympathetic nerve activity reduce renal blood flow and urinary sodium excretion by activation of α1-adrenoceptors and increase renin secretion rate by activation of β1-adrenoceptors. In response to normal physiological stimulation, changes in efferent renal sympathetic nerve activity contribute importantly to homeostatic regulation of sodium and water balance. The renal mechanosensory nerves are activated by stretch of the renal pelvic tissue produced by increases in renal pelvic tissue of a magnitude that may occur during increased urine flow rate. Activation of the sensory nerves elicits an inhibitory renorenal reflex response consisting of decreases in efferent renal sympathetic nerve activity leading to natriuresis. Increasing efferent sympathetic nerve activity increases afferent renal nerve activity which, in turn, decreases efferent renal sympathetic nerve activity by activation of the renorenal reflexes. Thus, activation of the afferent renal nerves buffers changes in efferent renal sympathetic nerve activity in the overall goal of maintaining sodium balance. In pathological conditions of sodium retention, impairment of the inhibitory renorenal reflexes contributes to an inappropriately increased efferent renal sympathetic nerve activity in the presence of sodium retention. In states of renal disease or injury, there is a shift from inhibitory to excitatory reflexes originating in the kidney. Studies in essential hypertensive patients have shown that renal denervation results in long-term reduction in arterial pressure, suggesting an important role for the efferent and afferent renal nerves in hypertension. Table of Contents: Part I: Efferent Renal Sympathetic Nerves / Introduction / Neuroanatomy / Neural Control of Renal Hemodynamics / Neural Control of Renal Tubular Function / Neural Control of Renin Secretion Rate / Part II: Afferent Renal Sensory Nerves / Introduction / Neuroanatomy / Renorenal Reflexes / Mechanisms Involved in the Activation of Afferent Renal Sensory Nerves / Part III: Pathophysiological States / Efferent Renal Sympathetic Nerves / Afferent Renal Sensory Nerves / Conclusions / References

In the second century, Galen recognized that nerve and muscle were functionally inseparable since contraction of muscle occurred only if the nerves supplying that muscle were intact. He therefore concluded that the shortening of a muscle was controlled by the central nervous sytem while the extension of a muscle could occur in the absence of innervation. Nerves, he thought, were the means of transport for animal spirits to the muscles; the way in which animal spirits may bring about contraction dominated the study of muscle physiology from that time until the historical discovery of Galvani that muscle could be stimulated electrically and that nerve and muscle were themselves a source of electrical energy. It is now well known that nerves conduct electrically and that transmission from nerve to striated muscle is mediated by the chemical which is liberated from nerve terminals onto the muscle membrane. In vertebrates this chemical is acetylcholine (ACh). Thus the concept of spirits that are released from nerves and control muscle contraction directly, is no longer tenable. Nevertheless the concept of 'substances' transported down nerv~s which directly control many aspects of muscle has not been abandoned, and has in fact been frequently reinvoked to account for the long-term regula tion of many characteristics of muscle (see review by Gutmann, 1976) and for the maintenance of its structural integrity.

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