View of the Renin-Angiotensin System in Acute Kidney Injury Induced by Renal Ischemia-Reperfusion Injury

Abstract

Renal ischemia-reperfusion injury (RIRI) is a sequence of complicated events that is defined as a reduction of the blood supply followed by reperfusion. RIRI is the leading cause of acute kidney injury (AKI). Among the diverse mediators that take part in RIRI-induced AKI, the renin-angiotensin system (RAS) plays an important role via conventional (angiotensinogen, renin, angiotensin-converting enzyme (ACE), angiotensin (Ang) II, and Ang II type 1 receptor (AT1R)) and nonconventional (ACE2, Ang 1-7, Ang 1-9, AT2 receptor (AT2R), and Mas receptor (MasR)) axes. RIRI alters the balance of both axes so that RAS can affect RIRI-induced AKI. In overall, the alteration of Ang II/AT1R and AKI by RIRI is important to consider. This review has looked for the effects and interactions of RAS activities during RIRI conditions.

Updates for Cardio‐Kidney Protective Effects by Angiotensin Receptor‐Neprilysin Inhibitor: Requirement for Additional Evidence of Kidney Protection

“… 5 Renin secreted from the kidneys produces angiotensin I from angiotensinogen synthesized in the liver. 5 , 6 Angiotensin I is converted to angiotensin II by ACE. 6 Angiotensin II exerts a strong hypertensive effect by constricting peripheral blood vessels and increasing water and sodium reabsorption via enhanced angiotensin II type 1 receptor and aldosterone secretion.…”

“… 5 , 6 Angiotensin I is converted to angiotensin II by ACE. 6 Angiotensin II exerts a strong hypertensive effect by constricting peripheral blood vessels and increasing water and sodium reabsorption via enhanced angiotensin II type 1 receptor and aldosterone secretion. 6 Additionally, angiotensin II is involved in remodeling and fibrosis in the heart, blood vessels, and kidneys.…”

“… 6 Angiotensin II exerts a strong hypertensive effect by constricting peripheral blood vessels and increasing water and sodium reabsorption via enhanced angiotensin II type 1 receptor and aldosterone secretion. 6 Additionally, angiotensin II is involved in remodeling and fibrosis in the heart, blood vessels, and kidneys. 6 , 7 ARBs specifically block angiotensin II type 1 receptor, and ACEIs inhibit ACE, which is required to convert angiotensin I to angiotensin II.…”

“… 6 Additionally, angiotensin II is involved in remodeling and fibrosis in the heart, blood vessels, and kidneys. 6 , 7 ARBs specifically block angiotensin II type 1 receptor, and ACEIs inhibit ACE, which is required to convert angiotensin I to angiotensin II. 8 RAS‐Is are believed to exhibit cardiorenal protective effects in addition to antihypertensive effects by inhibiting circulating RAS and local tissue RAS.…”

A comprehensive review of acute cardio-renal syndrome: need for novel biomarkers

“…Conventionally, systemic RAAS is critical for the maintenance of systemic or circulatory imbalances. In contrast, non-conventional axes of RAAS are a protective response to tissue injuries ( Sharma et al, 2019 ; Holappa et al, 2020 ; Karimi et al, 2022 ). In ADHF, renal hypoperfusion leads to the activation of systemic RAAS response in the kidney.…”