Stoian Marilena, Stoica Victor
Clinic of Internal Medicine, Dr.I.Cantacuzino Hospital, Bucharest, Romania.
"Carol Davila" University of Medicine, Bucharest, Romania.
J Med Life. 2020 Apr-Jun;13(2):116-118. doi: 10.25122/jml-2020-0006.
The role of the renin-angiotensin system in hypertension and end-organ damage has long been recognized. Angiotensin l converting enzyme inhibitors are superior to other antihypertensive agents in protecting the kidney against progressive deterioration, even in normotensive persons. Likewise, angiotensin II type 1 receptor antagonists improve or even reverse glomerulosclerosis in rat animal models. These findings suggest that Angiotensin II has nonhemodynamic effects in progressive renal disease. The renin-angiotensin system is now recognized to be linked to the induction of plasminogen activator-inhibitor-1, possibly via the AT4 receptor, thus promoting both thrombosis and fibrosis. Interactions of the renin-angiotensin system with aldosterone and bradykinin may impact both blood pressure and tissue injury. The beneficial effect on renal fibrosis of inhibiting the renin-angiotensin system likely reflects the central role that angiotensin has in regulating renal function and structure by its various actions. This article explores the renin-angiotensin-aldosterone system with plasminogen activator-inhibitor-1 interaction and the potential significance of these interactions in the pathogenesis of progressive renal disease and remodeling of renal sclerosis.
肾素-血管紧张素系统在高血压和靶器官损害中的作用早已得到认可。血管紧张素I转换酶抑制剂在保护肾脏免受进行性损害方面优于其他抗高血压药物，即使在血压正常的人群中也是如此。同样，血管紧张素II 1型受体拮抗剂在大鼠动物模型中可改善甚至逆转肾小球硬化。这些发现表明，血管紧张素II在进行性肾脏疾病中具有非血流动力学效应。现在认为肾素-血管紧张素系统与纤溶酶原激活物抑制剂-1的诱导有关，可能是通过AT4受体，从而促进血栓形成和纤维化。肾素-血管紧张素系统与醛固酮和缓激肽的相互作用可能影响血压和组织损伤。抑制肾素-血管紧张素系统对肾纤维化的有益作用可能反映了血管紧张素通过其各种作用在调节肾功能和结构中所起的核心作用。本文探讨了肾素-血管紧张素-醛固酮系统与纤溶酶原激活物抑制剂-1的相互作用以及这些相互作用在进行性肾脏疾病发病机制和肾硬化重塑中的潜在意义。
