Possible mechanism for the renoprotective effect of angiotensin converting enzyme inhibitors

Leopoldo Raij, P. J. Shultz, J. P. Tolins

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Hypertension is an important risk factor in the progression of renal failure, particularly in patients with pre-existing glomerulopathies such as diabetes and chronic glomerulonephritis. The mechanisms involved in hypertensive glomerular injury are currently unclear and cannot be studied in humans because of the constraints of human experimentation. However, recent animal studies have elucidated mechanisms which may explain the variable relationship between systemic hypertension and glomerular injury. Experimentally, at similar levels of systemic hypertension, glomerular injury only develops when preglomerular resistances are ineffective, thus allowing the development of glomerular hypertension. The mechanisms by which the haemodynamic stress of elevated intracapillary pressures and flows lead to progressive glomerular damage are at present unknown. Endothelial cell injury, increased mesangial traffic and/or trapping of macromolecules and epithelial cell injury appear to occur early, followed by in situ inflammatory and microthrombotic mechanisms. The intrarenal renin-angiotensin system appears to play an important role in the pathogenesis of progressive glomerular injury. Haemodynamically, angiotensin II (Ang II) has a relatively greater vasoconstrictive effect on efferent than on afferent arterioles. In addition, Ang II decreases the glomerular ultrafiltration coefficient. These combined effects result in increased intraglomerular capillary pressures. Angiotensin II increases the uptake and decreases the egress of circulating macromolecules in the glomerular mesangium and fosters mesangial cell mitogenesis. Thus, inhibition of Ang II generation may explain why angiotensin converting enzyme (ACE) inhibitors may be effective in arresting or slowing the progression of renal failure in experimental animals and in man.

Original languageEnglish
JournalJournal of Hypertension
Volume7
Issue numberSUPPL. 7
StatePublished - Dec 1 1989
Externally publishedYes

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Angiotensin-Converting Enzyme Inhibitors
Angiotensin II
Wounds and Injuries
Hypertension
Renal Insufficiency
Glomerular Mesangium
Human Experimentation
Pressure
Mesangial Cells
Ultrafiltration
Arterioles
Renin-Angiotensin System
Glomerulonephritis
Endothelial Cells
Hemodynamics
Epithelial Cells

ASJC Scopus subject areas

  • Endocrinology
  • Internal Medicine

Cite this

Possible mechanism for the renoprotective effect of angiotensin converting enzyme inhibitors. / Raij, Leopoldo; Shultz, P. J.; Tolins, J. P.

In: Journal of Hypertension, Vol. 7, No. SUPPL. 7, 01.12.1989.

Research output: Contribution to journalArticle

Raij, Leopoldo ; Shultz, P. J. ; Tolins, J. P. / Possible mechanism for the renoprotective effect of angiotensin converting enzyme inhibitors. In: Journal of Hypertension. 1989 ; Vol. 7, No. SUPPL. 7.
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