Huang Jane Hc, Lourenço Bianca N, Coleman Amanda E
Department of Small Animal Medicine and Surgery, University of Georgia, College of Veterinary Medicine, Athens 30601, USA.
Department of Small Animal Medicine and Surgery, University of Georgia, College of Veterinary Medicine, Athens 30601, USA.
Vet J. 2025 Feb;309:106287. doi: 10.1016/j.tvjl.2024.106287. Epub 2024 Dec 12.
The renin-angiotensin-aldosterone system (RAAS) has a well-established key pathophysiologic role in kidney diseases, and pharmacotherapy targeting this system is a mainstay of treatment of affected human beings, cats, and dogs. Several studies have evaluated the circulating RAAS in animals with spontaneous or experimentally induced kidney diseases. Evidence supporting the activation of this system has been demonstrated in some - but not all - studies and individuals, and the interindividual variability in circulating RAAS markers is high. Advances over the last few decades have expanded our understanding of the system, which now includes the existence of a counterbalancing "alternative" RAAS and tissular renin-angiotensin systems (RASs), the latter regulated independently of the circulating endocrine RAAS. The local RAS in the kidney, termed the intrarenal RAS, is currently recognized as an important regulator of kidney function and mediator of kidney disease. In general, information on the intrarenal RAS is lacking in cats and dogs with kidney diseases; however, existing limited data suggest its activation. Despite the inconsistent evidence for circulating RAAS activation in chronic kidney diseases, RAAS inhibitors have proven effective for the treatment of its common comorbidities, systemic arterial hypertension and renal proteinuria, in both cats and dogs. Further research of the circulating RAAS, the intrarenal RAS, and the interplay between these systems in the context of kidney diseases in companion animals might contribute to the development or refinement of future treatment strategies.
肾素-血管紧张素-醛固酮系统（RAAS）在肾脏疾病中具有明确的关键病理生理作用，针对该系统的药物治疗是人类、猫和狗等患病动物治疗的主要手段。多项研究评估了患有自发性或实验性诱导性肾脏疾病动物的循环RAAS。在一些（但并非所有）研究和个体中已证实支持该系统激活的证据，并且循环RAAS标志物的个体间变异性很高。过去几十年的进展扩展了我们对该系统的理解，现在包括存在一种起平衡作用的“替代性”RAAS和组织肾素-血管紧张素系统（RASs），后者独立于循环内分泌RAAS进行调节。肾脏中的局部RAS，称为肾内RAS，目前被认为是肾功能的重要调节因子和肾脏疾病的介质。一般来说，患有肾脏疾病的猫和狗缺乏关于肾内RAS的信息；然而，现有的有限数据表明其被激活。尽管在慢性肾脏疾病中循环RAAS激活的证据不一致，但RAAS抑制剂已被证明对治疗猫和狗的常见合并症，即系统性动脉高血压和肾蛋白尿有效。在伴侣动物肾脏疾病的背景下，对循环RAAS、肾内RAS以及这些系统之间相互作用的进一步研究可能有助于未来治疗策略的开发或完善。
