Coleman CM, Minor JJ, Burt LE, Thornhill BA, Forbes MS, Chevalier RL. Angiotensin AT1-receptor inhibition exacerbates renal injury resulting from partial unilateral ureteral obstruction in the neonatal rat. Am J Physiol Renal Physiol 293: F262-F268, 2007. First published April 18, 2007; doi:10.1152/ajprenal.00071.2007.-The renin-angiotensin system is activated in the developing kidney and is necessary for normal renal development, but is further activated by unilateral ureteral obstruction (UUO). During nephrogenesis, there is a switch from a preponderance of angiotensin AT2 to AT1 receptors in the rat. We examined the renal cellular response to angiotensin II receptor inhibition in the neonatal rat subjected to partial UUO under anesthesia within 48 h of birth. Group I ("early") received saline vehicle, losartan (AT1 inhibitor), or PD-123319 (AT2 inhibitor) during the completion of nephrogenesis in the first 10 days of life. Group II ("late") received each of the three treatments throughout the subsequent 10 days of life. Kidneys were harvested at 21 days, and the distribution of renin, apoptosis, macrophages, ␣-smooth muscle actin, and collagen was determined. Losartan and PD-123319 each increased vascular renin distribution in both kidneys. Partial UUO reduced growth and increased apoptosis, macrophages, ␣-smooth muscle actin, and collagen in the obstructed kidney. Early losartan treatment further increased ␣-smooth muscle actin and collagen in the obstructed kidney and induced apoptosis, macrophages, and collagen in the contralateral kidney. Late losartan treatment had no effect on any of the parameters in either kidney, and PD-123319 had no effect on either kidney. We conclude that selective inhibition of AT1 receptors during nephrogenesis (but not during subsequent renal maturation) exacerbates injury to the obstructed kidney and also injures the contralateral kidney. These results suggest that angiotensin II receptor blockers should be avoided in the developing hydronephrotic kidney.hydronephrosis; nephrogenesis; apoptosis; ␣-smooth muscle actin; collagen CONGENITAL URINARY TRACT OBSTRUCTION is a major cause of chronic renal insufficiency in infants and children (43). Despite intrauterine diagnosis and prompt evaluation and management of the neonate, the combination of fetal urinary tract maldevelopment and the consequences of urinary obstruction on the developing kidney lead to renal injury that is present even at the time of birth. Prevention of progression of renal injury in these infants is even more critical than in older patients with renal disorders.The renin-angiotensin system (RAS) has been shown to play a significant role in the progression of virtually all renal disorders, and pharmacological inhibition of angiotensin II is a widely accepted therapy for attenuating or preventing renal deterioration. Since the RAS is activated to a greater extent neonatally than at older ages, and urinary tract obstruction itself markedly activates the RAS, the rationale for angiotensin II inhibition in this set...