Abstract-We reported previously that urinary angiotensinogen (UAGT) levels provide a specific index of the intrarenal renin-angiotensin system (RAS) status in angiotensin II-dependent hypertensive rats. To study this system in humans, we recently developed a human angiotensinogen ELISA. To test the hypothesis that UAGT is increased in hypertensive patients, we recruited 110 adults. Four subjects with estimated glomerular filtration levels Ͻ30 mL/min per 1.73 m 2 were excluded because previous studies have already shown that UAGT is highly correlated with estimated glomerular filtration in this stage of chronic kidney disease. Consequently, 106 paired samples of urine and plasma were analyzed from 70 hypertensive patients (39 treated with RAS blockers [angiotensin-converting enzyme inhibitors or angiotensin II type 1 receptor blockers; systolic blood pressure: 139Ϯ3 mm Hg] and 31 not treated with RAS blockers [systolic blood pressure: 151Ϯ4 mm Hg]) and 36 normotensive subjects (systolic blood pressure: 122Ϯ2 mm Hg). UAGT, normalized by urinary concentrations of creatinine, were not correlated with race, gender, age, height, body weight, body mass index, fractional excretion of sodium, plasma angiotensinogen levels, or estimated glomerular filtration. However, UAGT/urinary concentration of creatinine was significantly positively correlated with systolic blood pressure, diastolic blood pressure, urinary albumin:creatinine ratio (rϭ0.5994), and urinary protein:creatinine ratio (rϭ0.4597). UAGT/urinary concentration of creatinine was significantly greater in hypertensive patients not treated with RAS blockers (25.00Ϯ4.96 g/g) compared with normotensive subjects (13.70Ϯ2.33 g/g). Importantly, patients treated with RAS blockers exhibited a marked attenuation of this augmentation (13.26Ϯ2.60 g/g). These data indicate that UAGT is increased in hypertensive patients, and treatment with RAS blockers suppresses UAGT, suggesting that the efficacy of RAS blockade to reduce the intrarenal RAS activity can be assessed by measurements of UAGT.

The increased activity of intrarenal renin–angiotensin system (RAS) in a setting of elevated arterial pressure elicits renal vasoconstriction, increased sodium reabsorption, proliferation, fibrosis and renal injury. Increases in intrarenal and interstitial angiotensin (Ang) II levels are due to increased AT1 receptor mediated Ang II uptake and stimulation of renal angiotensinogen (AGT) mRNA and protein expression. Augmented proximal tubule AGT production increases tubular AGT secretion and spillover of AGT into the distal nephron and urine. Increased renin formation by principal cells of the collecting ducts forms Ang I from AGT thus increasing Ang II. The catalytic actions of renin and prorenin are enhanced by prorenin receptors (PRRs) on the intercalated cells. The resultant increased intrarenal Ang II levels contribute to the genesis of chronic hypertension.

The objectives of this study were to determine the effects of chronic angiotensin II (ANG II) infusions on ANG II content and angiotensinogen expression in the mouse kidney and the role of the angiotensin II type 1 receptor (AT 1R) in mediating these changes. C57BL/6J male mice were subjected to ANG II infusions at doses of 400 or 1,000 ng⅐kg Ϫ1 ⅐min Ϫ1 either alone or with an AT 1R blocker (olmesartan; 3 mg⅐kg Ϫ1 ⅐day Ϫ1) for 12 days. Systolic and mean arterial pressures were determined by tail-cuff plethysmography and radiotelemetry. On day 13, blood and kidneys were collected for ANG II determinations by radioimmunoanalysis and intrarenal angiotensinogen expression studies by quantitative RT-PCR, Western blotting, and immunohistochemistry. ANG II infusions at the low dose elicited progressive increases in systolic blood pressure (135 Ϯ 2.5 mmHg). In contrast, the high dose induced a rapid increase (152 Ϯ 2.5, P Ͻ 0.05 vs. controls, 109 Ϯ 2.8). Renal ANG II content was increased by ANG II infusions at the low dose (1,203 Ϯ 253 fmol/g) and the high dose (1,258 Ϯ 173) vs. controls (499 Ϯ 40, P Ͻ 0.05). Kidney angiotensinogen mRNA and protein were increased only by the low dose to 1.13 Ϯ 0.02 and 1.26 Ϯ 0.10, respectively, over controls (1.00, P Ͻ 0.05). These effects were not observed in mice infused at the high dose and those receiving olmesartan. The results indicate that chronic ANG II infusions augment mouse intrarenal ANG II content with AT 1R-dependent uptake occurring at both doses, but only the low dose of infusion, which elicited a slow progressive response, causes an AT 1R-dependent increase in intrarenal angiotensinogen expression. telemetry; mouse kidney; hypertension CHRONIC INFUSIONS OF ANGIOTENSIN II (ANG II) lead to elevations in intrarenal ANG II content associated with reductions in renal function and sodium excretion and hypertension (26,29,31,35). An increase in intrarenal ANG II content is also associated with enhanced oxidative stress and chronic proinflammatory and proliferative responses that result in progressive tissue injury (7,18). Indeed, every model of experimental ANG II-dependent hypertension is characterized by augmentation of intrarenal ANG II content to levels much greater than can be explained on the basis of equilibration with the systemic circulation (8,23,39).Augmentation of intrarenal ANG II occurs by several processes. ANG II is actively accumulated in the kidney via internalization mainly by the ANG II type 1 receptor (AT 1 R) (20,38,39). However, megalin, an abundant protein in proximal tubule cells, can also bind and internalize ANG II (6). In addition, the kidneys express all components of the reninangiotensin system (RAS) and can therefore generate angiotensin peptides from locally formed angiotensinogen (9,11,17,25). Increased ANG II exerts a positive effect on the expression of angiotensinogen mRNA and protein by proximal tubule cells in ANG II-infused rats that translates into an elevation of angiotensinogen excretion in the urine (13,14,27). The intrarenal activi...

We previously reported that urinary excretion rates of angiotensinogen (AGT) provide a specific index of the activity of the intrarenal renin-angiotensin system in angiotensin II-dependent hypertensive rats. Meanwhile, we have recently developed direct enzyme-linked immunosorbent assays (ELISAs) to measure plasma and urinary AGT in humans. This study was performed to test a hypothesis that urinary AGT levels are enhanced in chronic kidney disease (CKD) patients and correlated with some clinical parameters. Eighty patients with CKD (37 women and 43 men, from 18 to 94 years old) and seven healthy volunteers (two women and five men, from 27 to 43 years old) were included. Plasma AGT levels showed a normal distribution; however, urinary AGT-creatinine ratios (UAGT/UCre) deviated from the normal distribution. When a logarithmic transformation was executed, Log(UAGT/UCre) levels showed a normal distribution. Therefore, Log(UAGT/UCre) levels were used for further analyses. Log(UAGT/UCre) levels were not correlated with age, gender, height, body weight, body mass index, systolic blood pressure, diastolic blood pressure, serum sodium levels, serum potassium levels, urinary sodium-creatinine ratios, plasma renin activity, or plasma AGT levels. However, Log(UAGT/UCre) levels were significantly correlated positively with urinary albumin-creatinine ratios, fractional excretion of sodium, urinary protein-creatinine ratios, and serum creatinine, and correlated negatively with estimated glomerular filtration rate. Log(UAGT/ UCre) levels were significantly increased in CKD patients compared with control subjects (1.8801 ± 0.0885 vs. 0.9417 ± 0.1048; P = .0024). These data confirmed our earlier report and showed that a new ELISA assay is a valid approach for measuring urinary AGT.

We recently reported that urinary excretion rates of angiotensinogen (U(AGT)) provide a specific index of intrarenal renin-angiotensin (ANG) system (RAS) status in ANG II-dependent hypertensive rats. When this is shown to be applicable to human subjects, a diagnostic test to identify those hypertensive patients most likely to respond to an RAS blockade could provide useful information to allow a mechanistic rationale for selection of an optimized approach to treatment of hypertensive patients. However, simple and accurate methods to measure human angiotensinogen (hAGT) are unavailable. For future studies of human subjects, we developed antibodies and a sensitive and specific quantification system for hAGT using a sandwich ELISA. We raised two antibodies against hAGT: a mouse monoclonal antibody and a rabbit polyclonal antibody. The standard curve of this ELISA exhibited a high linearity (0.31-20 ng/ml). The correlation coefficient was >0.99. Plasma angiotensinogen concentrations of healthy volunteers ranged from 28 to 71 microg/ml (n = 10). The ratio of U(AGT) to urinary creatinine concentration ranged from 5.0 to 30 microg/g (n = 7). Intra- and interassay coefficients of variation ranged from 4.4 to 5.5% and from 4.3 to 7.0%, respectively. This ELISA system had no cross-reactivity with major proteins in proteinuric urine samples, such as human albumin, immunoglobulin, or transferrin. Moreover, the cross-reactivity of the system with angiotensin peptides was also negligible. This hAGT ELISA will be a useful tool to investigate the relationship of U(AGT) and reactivity to antihypertensive drugs in hypertensive patients.