OBJECTIVE: To study which renin-angiotensin-aldosterone system (RAAS) component best reflects renal RAAS activity. METHODS AND RESULTS: We measured urinary and plasma renin, prorenin, angiotensinogen, aldosterone, albumin and creatinine in 101 diabetic and nondiabetic patients with or without hypertension. Plasma prorenin was elevated in diabetic patients. Urinary prorenin was undetectable. Urinary albumin and renin were higher in diabetic patients. Men had higher plasma renin/prorenin levels, and lower plasma angiotensinogen levels than women. Plasma creatinine and albumin were also higher in men. Urinary RAAS components showed no sexual dimorphism, whereas urinary creatinine and albumin were higher in men. Angiotensin-converting enzyme inhibitors and angiotensin II type 1 receptor blockers increased plasma renin and decreased plasma angiotensinogen, without altering plasma aldosterone. In contrast, in urine, these drugs decreased renin and aldosterone without affecting angiotensinogen. When analyzing all patients together, urinary angiotensinogen excretion closely mimicked that of albumin, whereas urinary angiotensinogen and albumin levels both were 0.05% or less of their concomitant plasma levels. This may reflect the identical glomerular filtration and tubular handling of both proteins, which have a comparable molecular weight. In contrast, urinary renin excretion did not correlate with urinary albumin excretion, and the urinary/plasma concentration ratio of renin was more than 200 times the ratio of albumin, despite its comparable molecular weight. Urinary aldosterone excretion closely followed urinary creatinine excretion. CONCLUSION: The increased urinary renin levels in diabetes and the decreased urinary renin levels following RAAS blockade, occurring independently of changes in plasma renin, reflect the activated renal RAAS in diabetes and the success of RAAS blockade in the kidney, respectively. Urinary renin, therefore, more closely reflects renal RAAS activity than urinary angiotensinogen or aldosterone.
OBJECTIVE: To study which renin-angiotensin-aldosterone system (RAAS) component best reflects renal RAAS activity. METHODS AND RESULTS: We measured urinary and plasma renin, prorenin, angiotensinogen, aldosterone, albumin and creatinine in 101 diabetic and nondiabeticpatients with or without hypertension. Plasma prorenin was elevated in diabeticpatients. Urinary prorenin was undetectable. Urinary albumin and renin were higher in diabeticpatients. Men had higher plasma renin/prorenin levels, and lower plasma angiotensinogen levels than women. Plasma creatinine and albumin were also higher in men. Urinary RAAS components showed no sexual dimorphism, whereas urinary creatinine and albumin were higher in men. Angiotensin-converting enzyme inhibitors and angiotensin II type 1 receptor blockers increased plasma renin and decreased plasma angiotensinogen, without altering plasma aldosterone. In contrast, in urine, these drugs decreased renin and aldosterone without affecting angiotensinogen. When analyzing all patients together, urinary angiotensinogen excretion closely mimicked that of albumin, whereas urinary angiotensinogen and albumin levels both were 0.05% or less of their concomitant plasma levels. This may reflect the identical glomerular filtration and tubular handling of both proteins, which have a comparable molecular weight. In contrast, urinary renin excretion did not correlate with urinary albumin excretion, and the urinary/plasma concentration ratio of renin was more than 200 times the ratio of albumin, despite its comparable molecular weight. Urinary aldosterone excretion closely followed urinary creatinine excretion. CONCLUSION: The increased urinary renin levels in diabetes and the decreased urinary renin levels following RAAS blockade, occurring independently of changes in plasma renin, reflect the activated renal RAAS in diabetes and the success of RAAS blockade in the kidney, respectively. Urinary renin, therefore, more closely reflects renal RAAS activity than urinary angiotensinogen or aldosterone.
Authors: Lodi C W Roksnoer; Bart F J Heijnen; Daisuke Nakano; Janos Peti-Peterdi; Stephen B Walsh; Ingrid M Garrelds; Jeanette M G van Gool; Robert Zietse; Harry A J Struijker-Boudier; Ewout J Hoorn; A H Jan Danser Journal: Hypertension Date: 2016-02-29 Impact factor: 10.190
Authors: Lodi C W Roksnoer; Koen Verdonk; Anton H van den Meiracker; Ewout J Hoorn; Robert Zietse; A H Jan Danser Journal: Curr Hypertens Rep Date: 2013-04 Impact factor: 5.369
Authors: Lodi C W Roksnoer; Koen Verdonk; Ingrid M Garrelds; Jeanette M G van Gool; Robert Zietse; Ewout J Hoorn; A H Jan Danser Journal: Clin J Am Soc Nephrol Date: 2014-04-17 Impact factor: 8.237