Clinical Disease and the Glomerulus

Kidney International (1994) 45, 403–410; doi:10.1038/ki.1994.52

The paradox of the renin-angiotensin system in chronic renal disease

Mark E Rosenberg1, Lawrence J Smith1, Ricardo Correa-Rotter1 and Thomas H Hostetter1

1Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA

Correspondence: Mark E Rosenberg MD, 736 UMHC, 516 Delaware Street S.E., University of Minnesota, Minneapolis, Minnesota 55455.

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Abstract

The renin-angiotensin system (RAS) plays a pathophysiologic role in the progression of chronic renal disease. Inhibition of angiotensin II (Ang II) in experimental and human renal diseases decreases proteinuria, reduces histologic evidence of renal injury, and slows progression to end-stage renal failure. However, available measurements of components of the RAS in most experimental models and clinical types of chronic renal disease do not suggest extraordinary systemic activation of this system. In this article we will examine this apparent paradox and offer several explanations for why this paradox might exist.

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