Antlanger Marlies, Domenig Oliver, Kovarik Johannes J, Kaltenecker Christopher C, Kopecky Chantal, Poglitsch Marko, Säemann Marcus D
1 Medical University of Vienna, Department of Internal Medicine III, Clinical Division of Nephrology and Dialysis, Austria.
2 Attoquant Diagnostics, Austria.
J Renin Angiotensin Aldosterone Syst. 2017 Apr-Jun;18(2):1470320317705232. doi: 10.1177/1470320317705232.
We aimed at assessing the molecular adaptation of the renin-angiotensin system (RAS) after successful kidney transplantation (KTX).
In this prospective, exploratory study we analyzed 12 hemodialysis (HD) patients, who received a KTX and had excellent graft function six to 12 months thereafter. The concentrations of plasma Angiotensin (Ang) peptides (Ang I, Ang II, Ang-(1-7), Ang-(1-5), Ang-(2-8), Ang-(3-8)) were simultaneously quantified with a novel mass spectrometry-based method. Further, renin and aldosterone concentrations were determined by standard immunoassays.
Ang values showed a strong inter-individual variability among HD patients. Yet, despite a continued broad dispersion of Ang values after KTX, a substantial improvement of the renin/Ang II correlation was observed in patients without RAS blockade or on angiotensin receptor blocker (HD: renin/Ang II R = 0.660, KTX: renin/Ang II R = 0.918). Ang-(1-7) representing the alternative RAS axis was only marginally detectable both on HD and after KTX.
Following KTX, renin-dependent Ang II formation adapts in non-ACE inhibitor-treated patients. Thus, a largely normal RAS regulation is reconstituted after successful KTX. However, individual Ang concentration variations and a lack of potentially beneficial alternative peptides after KTX call for individualized treatment. The long-term post-transplant RAS regulation remains to be determined.
我们旨在评估肾移植（KTX）成功后肾素-血管紧张素系统（RAS）的分子适应性。
在这项前瞻性探索性研究中，我们分析了12例接受KTX且术后6至12个月移植肾功能良好的血液透析（HD）患者。采用一种基于质谱的新方法同时定量血浆血管紧张素（Ang）肽（Ang I、Ang II、Ang-(1-7)、Ang-(1-5)、Ang-(2-8)、Ang-(3-8)）的浓度。此外，通过标准免疫测定法测定肾素和醛固酮浓度。
HD患者的Ang值显示出强烈的个体间变异性。然而，尽管KTX后Ang值仍持续广泛分散，但在未使用RAS阻滞剂或使用血管紧张素受体阻滞剂的患者中，肾素/Ang II相关性有显著改善（HD：肾素/Ang II R = 0.660，KTX：肾素/Ang II R = 0.918）。代表替代性RAS轴的Ang-(1-7)在HD时和KTX后仅能微量检测到。
KTX后，在未接受ACE抑制剂治疗的患者中，肾素依赖性Ang II的形成发生适应。因此，成功的KTX后可重建基本正常的RAS调节。然而，KTX后个体Ang浓度的变化以及缺乏潜在有益的替代肽提示需要个体化治疗。移植后RAS的长期调节仍有待确定。
