{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T07:02:12Z","timestamp":1779778932921,"version":"3.53.1"},"reference-count":67,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurosci."],"abstract":"<jats:p>Hypertensive Chronic Kidney Disease (CKD) constitutes a significant global health burden, characterized by a vicious cycle of hypertension and progressive renal decline. Autonomic imbalance, specifically sympathetic overactivity and parasympathetic withdrawal, is increasingly recognized as a central driver of this pathophysiology, interacting with traditional hemodynamic factors such as RAAS activation and volume overload. This review aims to elucidate the deep-seated mechanisms by which autonomic imbalance induces vascular injury and renal progression, and to evaluate the clinical potential of ultrasound-guided sympathetic blockade as a novel therapeutic strategy. We conducted a comprehensive narrative review of recent basic research and clinical evidence regarding the \u201cKidney-Brain-Vascular Axis\u201d and neuromodulation therapies in the context of hypertensive CKD. The pathogenesis involves a maladaptive \u201cNeuro-Immune-Vascular Axis.\u201d Sympathetic overactivity not only induces hemodynamic stress but also disrupts the Th1\/Th2 immune balance, accelerating vascular calcification and fibrosis. Ultrasound-guided sympathetic blockade offers a reversible, minimally invasive neuromodulation approach. Preliminary clinical evidence suggests it may lower blood pressure, improves vascular endothelial function, and potentially delays renal progression, particularly in patients with resistant hypertension, with a superior safety profile compared to renal denervation. Ultrasound-guided sympathetic blockade represents an emerging and investigational adjunct, constrained by the lack of large-scale randomized controlled trials and long-term outcome data.<\/jats:p>","DOI":"10.3389\/fnins.2026.1836903","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T06:03:12Z","timestamp":1779775392000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Autonomic imbalance and vascular injury in hypertensive chronic kidney disease: mechanisms and clinical potential of ultrasound-guided sympathetic blockade"],"prefix":"10.3389","volume":"20","author":[{"given":"Xiang","family":"Gao","sequence":"first","affiliation":[{"name":"Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhimin","family":"Fu","sequence":"additional","affiliation":[{"name":"Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeyu","family":"Wang","sequence":"additional","affiliation":[{"name":"Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhigan","family":"Lv","sequence":"additional","affiliation":[{"name":"Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiwei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1325","DOI":"10.1007\/s40122-024-00650-1","article-title":"Lumbar sympathetic block to treat CRPS in an 18-month-old girl: a breaking barriers case report and review of literature","volume":"13","author":"Ayad","year":"2024","journal-title":"Pain Ther."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2476","DOI":"10.1016\/S0140-6736(21)00788-1","article-title":"Ultrasound renal denervation for hypertension resistant to a triple medication pill (RADIANCE-HTN TRIO): a randomised, multicentre, single-blind, sham-controlled trial","volume":"397","author":"Azizi","year":"2021","journal-title":"Lancet"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2335","DOI":"10.1016\/S0140-6736(18)31082-1","article-title":"Endovascular ultrasound renal denervation to treat hypertension (RADIANCE-HTN SOLO): a multicentre, international, single-blind, randomised, sham-controlled trial","volume":"391","author":"Azizi","year":"2018","journal-title":"Lancet"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"2219","DOI":"10.1056\/NEJMoa2025845","article-title":"Effect of Finerenone on chronic kidney disease outcomes in type 2 diabetes","volume":"383","author":"Bakris","year":"2020","journal-title":"N. 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