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The authors suggest that limited kidney damage, even without affecting kidney function, may cause sympathetic and renin system activation in various disease states including essential hypertension.
We thank Schlaich et al 1 for their comment. We fully agree that the pathogenesis may vary in the various disease conditions known to have sympathetic hyperactivity. Essential hypertension is a heterogenous condition. 3] Experimental evidence has shown that already limited kidney damage, not necessarily affecting kidney function, can result in sympathetic activation. We put forward that, apart from chronic kidney disease, such a condition of (limited) kidney damage may be present in many disease states, resulting in activation of both the renin and the sympathetic system.
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Neumann et al. (2007) studied this question.
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