Department of Nephrology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
Adv Exp Med Biol. 2019;1165:671-691. doi: 10.1007/978-981-13-8871-2_33.
The rennin-angiotensin-aldosterone system (RAAS) has been well documented in regulating blood pressure, fluid volume, and sodium balance. Overactivity of RAAS promotes both systemic and regional glomerular capillary hypertension, which could induce hemodynamic injury to the glomerulus, leading to kidney damage and renal fibrosis via profibrotic and proinflammatory pathway. Therefore, the use of RAAS inhibitors (i.e., ACEIs, ARBs, and MRAs) as the optional therapy has been demonstrated to prevent proteinuria, and kidney fibrosis and slow the decline of renal function effectively in the process of kidney disease during the last few decades. Recently, several new components of the RAAS have been discovered, including ACE2 and the corresponding ACE2/Ang (1-7)/Mas axis, which are also present in the kidney. Besides the classic RAAS inhibitors target the angiotensin-AT1-aldosterone axis, with the expanding knowledge about RAAS, a number of potential therapeutic targets in this system is emerging. Newer agents that are more specific are being developed. The present chapter outlines the insights of the RAAS agents (classic RAAS antagonists/the new RAAS drugs), and discusses its clinical application in the combat of renal fibrosis.
肾素-血管紧张素-醛固酮系统（RAAS）在调节血压、血容量和钠平衡方面已有充分的文献记载。RAAS 的过度活跃会促进全身和局部肾小球毛细血管高血压，这可能导致肾小球的血液动力学损伤，通过成纤维和炎症途径导致肾脏损伤和肾纤维化。因此，在过去几十年的肾病过程中，使用 RAAS 抑制剂（即 ACEI、ARB 和 MRA）作为可选治疗方法已被证明可有效预防蛋白尿、肾脏纤维化并减缓肾功能下降。最近，已经发现了 RAAS 的几个新成分，包括 ACE2 和相应的 ACE2/Ang（1-7）/Mas 轴，它们也存在于肾脏中。除了经典的 RAAS 抑制剂针对血管紧张素-AT1-醛固酮轴外，随着对 RAAS 的了解不断扩大，该系统中的许多潜在治疗靶点正在出现。正在开发更具特异性的新型药物。本章概述了 RAAS 药物（经典 RAAS 拮抗剂/新 RAAS 药物）的研究进展，并讨论了其在对抗肾纤维化方面的临床应用。
