Bérard Etienne, Niel Olivier, Rubio Amandine
Unité de néphrologie pédiatrique, Hôpital Archet 2, Hôpitaux pédiatriques universitaires de Nice, 151 route de Saint Antoine Ginestière, 06202, Nice cedex 3, France,
Pediatr Nephrol. 2014 Jun;29(6):951-60. doi: 10.1007/s00467-013-2481-0. Epub 2013 Jun 6.
The historical view of the renin-angiotensin system (RAS) is that of an endocrine hypertensive system that is controlled by renin and mediated via the action of angiotensin II on its type 1 receptor. Numerous new angiotensins (Ang) and receptors have been described, the majority being hypotensive and natriuretic, namely Ang-(1-7) and its receptor rMas. Renin and its precursor (pro-renin) can bind their common receptor. In addition to the production of Ang II, this receptor triggers intracellular effects. Given the control of renin production by intracellular calcium, calcium homeostasis is of particular importance. Ang-(1-12), which is not controlled by renin, is converted to several different angiotensin peptides and is a new pathway of the RAS. Local RAS enzymes produce or transform the different hyper- or hypotensive angiotensin within vessels and organs, but also in blood through circulating forms of the enzymes. In the kidney, a powerful local vascular RAS allows for the independence of renal vascularization from systemic control. Moreover, the kidney also contains an independent urinary RAS, which counterbalances the systemic RAS and coordinates proximal and distal sodium reabsorption. The systemic and local effects of renal RAS cannot be analyzed without taking into account the antagonistic effect of renalase. Our concept of RAS needs to evolve to take into account its dual potentiality (hyper- or hypotensive).
肾素-血管紧张素系统(RAS)的传统观点认为它是一个由肾素控制、通过血管紧张素II作用于其1型受体介导的内分泌性高血压系统。现已发现了许多新的血管紧张素(Ang)和受体,其中大多数具有降压和利钠作用,如Ang-(1-7)及其受体rMas。肾素及其前体(肾素原)可结合其共同受体。除了产生血管紧张素II外,该受体还能引发细胞内效应。鉴于细胞内钙对肾素产生的控制,钙稳态尤为重要。不受肾素控制的Ang-(1-12)可转化为几种不同的血管紧张素肽,这是RAS的一条新途径。局部RAS酶在血管、器官内以及通过酶的循环形式在血液中产生或转化不同的升压或降压血管紧张素。在肾脏中,强大的局部血管RAS使肾血管化独立于全身控制。此外,肾脏还含有一个独立的尿RAS,它可抵消全身RAS的作用并协调近端和远端钠重吸收。如果不考虑肾酶的拮抗作用,就无法分析肾脏RAS的全身和局部效应。我们对RAS的概念需要不断发展,以考虑到其双重潜能(升压或降压)。