New Approaches to Blockade of the Renin–Angiotensin–Aldosterone System: Mineralocorticoid-Receptor Blockers Exert Antihypertensive and Renoprotective Effects Independently of the Renin–Angiotensin System

2010 ◽  
Vol 113 (4) ◽  
pp. 310-314 ◽  
Author(s):  
Akira Nishiyama ◽  
Koichi Hasegawa ◽  
Suwarni Diah ◽  
Hirofumi Hitomi
Keyword(s):  
Mineralocorticoid Receptor ◽  
Renin Angiotensin System ◽  
Renin Angiotensin Aldosterone System ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
New Approaches ◽  
Receptor Blockers

scholarly journals How to potentialize the effect of renin-angiotensin-aldosterone system inhibitors?

KIDNEYS ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 156-161
Author(s):  
D.D. Ivanov
Keyword(s):  
Current Trend ◽  
Renin Angiotensin System ◽  
Significant Loss ◽  
Scientific Review ◽  
Renin Angiotensin Aldosterone System ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Excretory Function ◽  
Ckd Stage ◽  
Lespedeza Capitata

The scientific review presents a practical analysis of the properties of Lespedeza capitata in terms of its attractiveness for nephrological practice. Lespedeza shows many effects on ectoderm derivatives, including skin and the kidneys. Thus, the results of studies showed significant stimulation of the growth of fibroblasts and keratinocytes, as well as increased collagen synthesis with a lipolytic effect on adipocytes. The researchers concluded the possibility of using herbal medicinal preparations of Lespedeza capitata to stimulate skin cells and tissue regeneration, for anti-aging therapy and induction of lipolysis due to flavonoid extract. Lespedeza capitata extract enhances diuresis, eliminates edema, reduces azotaemia and albuminuria, increases sodium excretion, and to lesser extent potassium, promotes renal filtration and excretion of nitrogenous products in the urine. The advantages of phytotherapy in normalizing the capillary permeability of the glomeruli are a mild diuretic effect, which prevents a significant loss of electrolytes in contrast to synthetic diuretics. These effects are now considered as potentiating the action of inhibitors of the renin-angiotensin system, which is the basis of renoprotection in modern nephrology. Lespedeza flavonoids improve protein-energy metabolism, which has been demonstrated in many models of acute renal failure. Correction of protein metabolism has a favourable nephroprotective effect and slows the progression of chronic kidney disease (CKD) while maintaining normal excretory function. Lespedeza extract can be considered as a substance that enhances the action of renin-angiotensin-aldosterone system inhibitors (RAASi), acting synergistically in inhibiting the activity of the renin-angiotensin system. This property of the drug becomes very relevant in patients with CKD stage 5 when the abolition of RAASi today corresponds to the current trend. Maintaining a small dose of RAASi in stage 10 CKD, or the use of RAASi with extrarenal elimination in combination with Lespedeza extract demonstrates encouraging results in clinical practice.

scholarly journals Renin-Angiotensin System Blockers and the COVID-19 Pandemic

Hypertension ◽  
2020 ◽  
Vol 75 (6) ◽  
pp. 1382-1385 ◽  
Author(s):  
A.H. Jan Danser ◽  
Murray Epstein ◽  
Daniel Batlle
Keyword(s):  
Angiotensin Ii ◽  
Severe Acute Respiratory Syndrome ◽  
Angiotensin Converting Enzyme ◽  
Renin Angiotensin System ◽  
Converting Enzyme ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Receptor Blockers ◽  
Renin Angiotensin System Blockers

During the spread of the severe acute respiratory syndrome coronavirus-2, some reports of data still emerging and in need of full analysis indicate that certain groups of patients are at risk of COVID-19. This includes patients with hypertension, heart disease, diabetes mellitus, and clearly the elderly. Many of those patients are treated with renin-angiotensin system blockers. Because the ACE2 (angiotensin-converting enzyme 2) protein is the receptor that facilitates coronavirus entry into cells, the notion has been popularized that treatment with renin-angiotensin system blockers might increase the risk of developing a severe and fatal severe acute respiratory syndrome coronavirus-2 infection. The present article discusses this concept. ACE2 in its full-length form is a membrane-bound enzyme, whereas its shorter (soluble) form circulates in blood at very low levels. As a mono-carboxypeptidase, ACE2 contributes to the degradation of several substrates including angiotensins I and II. ACE (angiotensin-converting enzyme) inhibitors do not inhibit ACE2 because ACE and ACE2 are different enzymes. Although angiotensin II type 1 receptor blockers have been shown to upregulate ACE2 in experimental animals, the evidence is not always consistent and differs among the diverse angiotensin II type 1 receptor blockers and differing organs. Moreover, there are no data to support the notion that ACE inhibitor or angiotensin II type 1 receptor blocker administration facilitates coronavirus entry by increasing ACE2 expression in either animals or humans. Indeed, animal data support elevated ACE2 expression as conferring potential protective pulmonary and cardiovascular effects. In summary, based on the currently available evidence, treatment with renin-angiotensin system blockers should not be discontinued because of concerns with coronavirus infection.

Salt-sensitive hypertension in chronic kidney disease: distal tubular mechanisms

2020 ◽  
Vol 319 (5) ◽  
pp. F729-F745
Author(s):  
Dominique M. Bovée ◽  
Catharina A. Cuevas ◽  
Robert Zietse ◽  
A. H. Jan Danser ◽  
Katrina M. Mirabito Colafella ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Mineralocorticoid Receptor ◽  
Kidney Injury ◽  
Renin Angiotensin System ◽  
Distal Nephron ◽  
T Helper 17 ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Salt Sensitive Hypertension

Chronic kidney disease (CKD) causes salt-sensitive hypertension that is often resistant to treatment and contributes to the progression of kidney injury and cardiovascular disease. A better understanding of the mechanisms contributing to salt-sensitive hypertension in CKD is essential to improve these outcomes. This review critically explores these mechanisms by focusing on how CKD affects distal nephron Na+ reabsorption. CKD causes glomerulotubular imbalance with reduced proximal Na+ reabsorption and increased distal Na+ delivery and reabsorption. Aldosterone secretion further contributes to distal Na+ reabsorption in CKD and is not only mediated by renin and K+ but also by metabolic acidosis, endothelin-1, and vasopressin. CKD also activates the intrarenal renin-angiotensin system, generating intratubular angiotensin II to promote distal Na+ reabsorption. High dietary Na+ intake in CKD contributes to Na+ retention by aldosterone-independent activation of the mineralocorticoid receptor mediated through Rac1. High dietary Na+ also produces an inflammatory response mediated by T helper 17 cells and cytokines increasing distal Na+ transport. CKD is often accompanied by proteinuria, which contains plasmin capable of activating the epithelial Na+ channel. Thus, CKD causes both local and systemic changes that together promote distal nephron Na+ reabsorption and salt-sensitive hypertension. Future studies should address remaining knowledge gaps, including the relative contribution of each mechanism, the influence of sex, differences between stages and etiologies of CKD, and the clinical relevance of experimentally identified mechanisms. Several pathways offer opportunities for intervention, including with dietary Na+ reduction, distal diuretics, renin-angiotensin system inhibitors, mineralocorticoid receptor antagonists, and K+ or H+ binders.

scholarly journals Renin-Angiotensin-System (RAS) und COVID-19 – Zur Verordnung von RAS-Blockern

2020 ◽  
Vol 145 (10) ◽  
pp. 682-686 ◽  
Author(s):  
Reinhold Kreutz ◽  
Engi Abd El-Hady Algharably ◽  
Detlev Ganten ◽  
Franz Messerli
Keyword(s):  
Angiotensin Receptor Blockers ◽  
Renin Angiotensin System ◽  
Short Review ◽  
Angiotensin Receptor ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Analysis And Evaluation ◽  
Receptor Blockers ◽  
Ras Blockers ◽  
Regulatory Functions

AbstractTwenty years ago, an enzyme homologous to the previously known angiotensin-converting enzyme (ACE) was identified, and subsequently named ACE2. In the renin-angiotensin system (RAS), ACE2 has counter-regulatory functions against the classical effector peptide angiotensin II, for example in blood pressure regulation and cardiovascular remodeling. However, ACE2 provides an initially unexpected interesting link between virology and cardiovascular medicine. That is, ACE2 represents the binding receptor for the cellular uptake of SARS-CoV and SARS-CoV-2 viruses. Thus, ACE2 is relevant for COVID-19. In this context, it was suspected that therapy with RAS blockers might promote transmission and complications of COVID-19 by upregulation of ACE2 expression. The aim of this short review is, to describe the link between the RAS, particularly ACE2, and COVID-19. Based on our analysis and evaluation of the available findings, we justify our conclusion: important drugs such as ACE inhibitors and angiotensin receptor blockers should continue to be prescribed according to guidelines to stable patients in the context of the COVID-19 pandemic.

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