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The renin-angiotensin system and renal function in kidney transplantation
A Mimran1, G Mourad, J Ribstein
1Department of Medicine and Nephrology, Centre Hospitalier Universitaire, Montpellier, France.
Abstract:
The use of converting enzyme inhibitors (CEI) has permitted us to assess the role of the renin-angiotensin system in the control of arterial pressure and renal function in various conditions. In renal transplant recipients treated by azathioprine and steroids, the occurrence of CEI-induced deterioration of renal function is highly suggestive of renal artery stenosis, whereas renal vasodilatation associated with unchanged glomerular filtration rate in response to CEI is indicative of a significant role of native kidneys. In hypertensive recipients without renal artery stenosis, the absence of renal hemodynamic changes after CEI may be predictive of subsequent chronic rejection. The information provided by CEI is rather different in cyclosporine treated subjects. In this setting, no acute effect of CEI on renal hemodynamics is detectable. Whether the renal response to CEI is similar in cyclosporine when compared to conventionally treated patients with renal artery stenosis remains to be demonstrated.
Insights
Converting enzyme inhibitors (CEI) reveal insights into renal artery stenosis and native kidney function in transplant recipients. Their effects differ significantly in patients treated with cyclosporine, highlighting distinct therapeutic responses.
Area of Science:
- Nephrology
- Cardiovascular Research
- Pharmacology
Background:
- The renin-angiotensin system plays a crucial role in regulating arterial pressure and renal function.
- Converting enzyme inhibitors (CEI) are valuable tools for assessing this system's impact.
- Understanding CEI effects in renal transplant recipients is vital for managing complications.
Purpose of the Study:
- To evaluate the diagnostic utility of CEI in renal transplant recipients.
- To differentiate between renal artery stenosis and native kidney function using CEI.
- To investigate the impact of CEI on renal hemodynamics in patients treated with cyclosporine.
Main Methods:
- Administration of CEI to renal transplant recipients.
- Monitoring of renal function and hemodynamic parameters.
- Comparison of responses in patients with and without renal artery stenosis, and with different immunosuppressive regimens.
Main Results:
- CEI-induced renal function deterioration suggests renal artery stenosis in azathioprine/steroid-treated recipients.
- Renal vasodilatation with stable glomerular filtration rate indicates native kidney function.
- Absence of hemodynamic changes in hypertensive recipients without stenosis may predict chronic rejection.
- No acute renal hemodynamic effects of CEI were observed in cyclosporine-treated subjects.
Conclusions:
- CEI provide distinct diagnostic information in renal transplant recipients based on their underlying renal status and immunosuppression.
- The response to CEI differs markedly between conventionally treated patients and those on cyclosporine.
- Further research is needed to clarify CEI effects in cyclosporine-treated patients with renal artery stenosis.