Methods for Therapeutic Renal Denervation

Abstract

Methods for therapeutic renal denervation are disclosed herein. One aspect of the present application, for example, is directed to methods that block, reduce and/or inhibit renal sympathetic nerve activity to achieve a reduction in central sympathetic tone. Renal sympathetic nerve activity may be altered or modulated along the afferent and/or efferent pathway. The achieved reduction in central sympathetic tone may carry several therapeutic benefits across many disease states.

1 . A method of treating a human patient diagnosed with a condition associated with central sympathetic hyperactivity, the method comprising:
 blocking, reducing or inhibiting neural activity in nerves that innervate an end organ of the patient; and   reducing central sympathetic drive in a manner that treats the patient for the diagnosed condition   
     
     
         2 . The method of  claim 1  wherein blocking, reducing or inhibiting afferent neural activity in nerves that innervate an end organ of the patient comprises inhibiting sympathetic neural signals in nerves that innervate a kidney of the patient. 
     
     
         3 . The method of  claim 2  wherein inhibiting sympathetic neural signals in nerves that innervate a kidney of the patient comprises modulating renal afferent neural activity. 
     
     
         4 . The method of  claim 2  wherein inhibiting sympathetic neural signals in nerves that innervate a kidney of the patient comprises modulating renal efferent neural activity. 
     
     
         5 . The method of  claim 1  wherein blocking, reducing or inhibiting sympathetic neural activity in nerves that innervate a kidney of the patient comprises ablating a renal nerve of the patient. 
     
     
         6 . The method of  claim 5  wherein ablating a renal nerve comprises thermally ablating the renal nerve. 
     
     
         7 . The method of  claim 6  wherein thermally ablating the renal nerve comprises necrosing the renal nerve via a cryoablation device. 
     
     
         8 . The method of  claim 6  wherein thermally ablating the renal nerve comprises delivering an energy field to the renal nerve via an energy element. 
     
     
         9 . The method of  claim 5  wherein ablating a renal nerve comprises ablating the renal nerve via an intravascularly positioned catheter. 
     
     
         10 . The method of  claim 9  wherein ablating the renal nerve via an intravascularly positioned catheter comprises ablating the renal nerve via a catheter from within a renal artery of the patient. 
     
     
         11 . The method of  claim 1  wherein blocking, reducing or inhibiting sympathetic neural activity in nerves that innervate a kidney of the patient comprises delivering a neuromodulatory agent to a renal nerve of the patient. 
     
     
         12 . The method of  claim 1  wherein reducing central sympathetic drive in a manner that treats the patient for the diagnosed condition comprises improving the patient's endothelial function. 
     
     
         13 . The method of  claim 1  wherein treating a human patient diagnosed with a condition associated with central sympathetic hyperactivity comprises treating the patient for resistant or refractory hypertension. 
     
     
         14 . The method of  claim 13  wherein treating the patient for resistant or refractory hypertension comprises reducing central sympathetic tone in a manner which lowers the patient's blood pressure. 
     
     
         15 . The method of  claim 14  wherein lowering the patient's blood pressure comprises lowering the patient's blood pressure to the point where the patient is no longer diagnosed with refractory or resistant hypertension. 
     
     
         16 . The method of  claim 1  wherein treating a human patient diagnosed with a condition associated with central sympathetic hyperactivity comprises treating the patient for chronic kidney disease or chronic renal failure. 
     
     
         17 . The method of  claim 16  wherein treating the patient for chronic kidney disease or chronic renal failure comprises slowing the decline in the glomerular filtration rate of the patient. 
     
     
         18 . The method of  claim 17  wherein slowing the decline in the glomerular filtration rate of the patient comprises reducing the rate of GFR decline beyond that which is attributable to a reduction in blood pressure. 
     
     
         19 . The method of  claim 1  wherein treating a human patient diagnosed with a condition associated with central sympathetic hyperactivity comprises treating the patient for heart failure. 
     
     
         20 . The method of  claim 19  wherein treating the patient for heart failure comprises treating the patient for diastolic heart failure. 
     
     
         21 . The method of  claim 19  wherein treating the patient for heart failure comprises reducing the patient's left ventricular mass. 
     
     
         22 . The method of  claim 21  wherein reducing the patient's left ventricular mass comprises causing regression of left ventricular hypertrophy. 
     
     
         23 . A method of treating a hypertensive patient who is treated with anti-hypertensive medications, the method comprising:
 blocking, reducing or inhibiting sympathetic neural activity in nerves that innervate a kidney of the patient; and   reducing the patient's dosage of anti-hypertensive medications.   
     
     
         24 . The method of  claim 23  wherein the hypertensive patient is on at least 3 different anti-hypertensive medications. 
     
     
         25 . The method of  claim 24  wherein reducing the patient's dosage of anti-hypertensive medications comprises eliminating one of the at least three anti-hypertensive medications. 
     
     
         26 . A method of treating a patient diagnosed with a condition associated with elevated sympathetic tone, the method comprising:
 blocking, reducing or inhibiting sympathetic neural activity in nerves that innervate a kidney of the patient; and   reducing central sympathetic drive in a manner that treats the patient for the diagnosed condition,   wherein the therapeutic response experienced by the patient is durable for at least twelve months following treatment.   
     
     
         27 . A method of treating a patient diagnosed with a condition associated with elevated sympathetic tone, the method comprising:
 blocking, reducing or inhibiting sympathetic neural activity in nerves that innervate a kidney of the patient; and   reducing central sympathetic drive in a manner that treats the patient for the diagnosed condition,   wherein the patient experiences a therapeutic response to the treatment that is equal to or greater than the therapeutic response experienced by the patient in response to pharmacological treatment.   
     
     
         28 . A method of determining whether a patient will respond to a renal denervation treatment, the method comprising:
 administering a pharmacologic challenge test to the patient; and   observing a consistent reduction in the patient's blood pressure in response to the administered pharmacologic challenge test.   
     
     
         29 . The method of  claim 28  wherein administering a pharmacologic challenge test to the patient comprises administering a central sympatholytic drug to the patient. 
     
     
         30 . The method of  claim 28  wherein administering a central sympatholytic drug to the patient comprises administering an alpha 2 adrenergic agonist to the patient. 
     
     
         31 . The method of  claim 30  wherein administering an alpha 2 adrenergic agonist to the patient comprises administering to the patient at least one of clonodine, guanfacine, and methyldopa. 
     
     
         32 . The method of  claim 28  wherein administering a central sympatholytic drug to the patient comprises administering an imidazoline receptor agonist to the patient. 
     
     
         33 . The method of  claim 32  wherein administering an imidazoline receptor agonist to the patient comprises administering moxonidine to the patient.