Objective The present study was designed to clarify whether the Rho–Rho-kinase pathway is involved in the process of hypertensive glomerulosclerosis and to assess the therapeutic effect of fasudil, a specific Rho-kinase inhibitor.

Method and results Dahl salt-sensitive rats (DS) and Dahl salt-resistant rats (DR) were fed a high-salt diet at 6 weeks of age. Fasudil (30 mg/kg per day) was administered for 7 weeks to DS starting at the age of 11 weeks. After 7 weeks, untreated DS were characterized by decreased kidney function, increased proteinuria, abnormal morphological findings, increased adrenomedullin and atrial natriuretic peptide (ANP) levels, and increased renal messenger RNA expression of RhoB, Rho-kinaseα, Rho-kinaseβ, collagen I and collagen III, and transforming growth factor-beta (TGF-β) in the renal cortex compared with DR. Chronic fasudil treatment significantly improved renal function (serum creatinine,–26%; blood urea nitrogen,–41%; creatinine clearance,+ 42%), proteinuria (–24%) and histological findings (glomerular injury score,–49%; afferent arteriolar injury score,–17%) without changing blood pressure compared with untreated DS. Interestingly, long-term fasudil treatment decreased the plasma adrenomedullin (–25%) and ANP (–49%), but did not change the plasma renin or aldosterone. Furthermore, fasudil significantly decreased the messenger RNA expression of TGF-β (–20%), collagen I (–23%), and collagen III (–24%) in the renal cortex. However, there were still significant differences in the aforementioned parameters between DR and fasudil-treated DS.

Conclusion These results suggest that the Rho–Rho-kinase pathway may be partly responsible for the pathogenesis of hypertensive glomerulosclerosis independently of blood pressure in DS, and that chronic inhibition of the Rho–Rho-kinase pathway may be a new strategy for treating hypertensive nephrosclerosis.