Kidney, renin level

The plasma level of angiotensin II is mainly determined by the rate at which renin is released by the kidneys. Renin is synthesized by juxtaglomerular cells, which release it when sodium levels decline or there is a fall in blood pressure. 

Teprotide s capacity to block the in vivo generation of angiotensin II from angiotensin I was demonstrated by its inhibition of the latter s pressor activity when both are given intravenously to rats (87). Teprotide was also shown to lower blood pressure in animal models of hypertension, especially those characterized by high circulating renin levels such as the two-kidney, one-clip rat model of renal hypertension (88). For reviews of teprotide pharmacology, see Cushman and Ondetti (72) and Ondetti and Cushman (73). 

In four normal men the elevated renin level induced by pretreatment with frusemide was suppressed by GH-RIH infusion, the st demonstration of an action of GH-RIH on the kidney (GIO), These results lend further support to the view that GH-RIH inhibits exocytic events mediated by calcium influx. 

In an attempt to conserve sodium, the kidney secretes renin increased plasma renin activity increases the release of aldosterone, which regulates the absorption of potassium and leads to kafluresis and hypokalemia. Hypokalemia is responsible in part for decreased glucose intolerance (82). Hyponatremia, postural hypotension, and pre-renal azotemia are considered of tittle consequence. Hypemricemia and hypercalcemia are not unusual, but are not considered harmful. However, hypokalemia, progressive decreased glucose tolerance, and increased semm cholesterol [57-88-5] levels are considered... 

Atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and C-type natriuretic peptide (CNP) are members of a family of so-called natriuretic peptides, synthesized predominantly in the cardiac atrium, ventricle, and vascular endothelial cells, respectively (G13, Y2). ANP is a 28-amino-acid polypeptide hormone released into the circulation in response to atrial stretch (L3). ANP acts (Fig. 8) on the kidney to increase sodium excretion and glomerular filtration rate (GFR), to antagonize renal vasoconstriction, and to inhibit renin secretion (Ml). In the cardiovascular system, ANP antagonizes vasoconstriction and shifts fluid from the intravascular to the interstitial compartment (G14). In the adrenal cortex, ANP is a powerful inhibitor of aldosterone synthesis (E6, N3). At the hypothalamic level, ANP inhibits vasopressin secretion (S3). It has been shown that some of the effects of ANP are mediated via a newly discovered hormone, called adreno-medullin, controlling fluid and electrolyte homeostasis (S8). The diuretic and blood pressure-lowering effect of ANP may be partially due to adrenomedullin (V5). 

The activity of the renin-angiotensin system is reduced with age (Muhlberg and Platt 1999). The ability of the kidney to concentrate urine maximally after water deprivation decreases with age, as does the ability to excrete a water and salt load, particularly during the night. Nocturnal polyuria is common in the elderly (Lubran 1995). Diuretics are commonly used in the elderly. There is an increased risk for hypokalemia and hyponatremia from diuretics in the elderly (Passare et al. 2004). Electrolyte disturbances may also be caused by several types of drugs in the elderly and it is important to monitor serum electrolyte levels in the elderly. Treatment with... 

Renin is secreted into the bloodstream by specialised cells in a portion of the distal tubules in the kidney (known as the macula densa). The rate of secretion is stimulated by several factors, including a low Na" ion concentration in the blood and an increase in sympathetic activity (i.e. an increase in the local level of noradrenaline). 

It is important to realize how difficult it is to define the in vivo inhibition of ACE. The enzyme may be explored for its N-terminal active sites by measurement of a constant and maximally increased level of N-acetyl SDKP in plasma and urine (211), but the residual activity of the C-ter-minal sites is probably not being measured. The methods for in vitro measurement of plasma ACE, except perhaps that described by Nuss-berger et al. (256), do not appropriately quantify global ACE inhibition. Moreover, the consequences of enzyme blockade are modified by secondary activation of the RAS (233). Residual amounts of angiotensin II secondary to a reactive rise in renin and angiotensin I may explain why the administration of an angiotensin II antagonist still has an additive effect on blood pressure and possibly on the heart, the vessels, and the kidney when added to certain doses of ACE inhibitors (228, 229, 257). 

Fig. 1.7 Possible mechanisms involving angiotensin II, oxidative stress and nitric oxide in enhanced Gi oc protein expression in hypertension. Gi protein expression is enhanced in genetic (SHR) and experimental hypertension including 1 kidney 1 clip (1K1C) and L-NAME-induced hypertension. Inhibition of nitric oxide synthase (NOS) by L-NAME activates renin angiotensin system, and also decreases the level of NO. 1K1C hypertensive rats also exhibit enhanced levels of Ang II. Ang II increases oxidative stress that through increased MAP kinase activity results in enhanced expression of Gi oc proteins and thereby hypertension. On the other hand, increased levels of NO and cGMP decrease the expression of Gia proteins in VSMC which may be an additional mechanism through which NO decreases blood pressure in L-NAME-induced hypertensive rats.

Human renin, a 340-amino-acid glycoprotein derived from a larger polypeptide, prorenin, is produced and secreted by the juxtaglomerular cells in the kidney. The presence of only low levels of renin in circulation made human renin difficult to obtain in quantities required for drug screens and structural studies. Therefore, the pepsin family of aspartyl proteases was used for the modeling of human renin in drug... 

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