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Effect of intrarenal renin-angiotensin-aldosterone system on renal function in patients after cardiac surgery

Peiyuan Niu1,2,3, Xuejing Ren1,2,3, Meihao Wu1,2,3

  • 1Department of Nephrology, Henan Provincial People's Hospital; People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, Henan, China.

Medicine
|April 1, 2022
PubMed

Insights

Increased intrarenal renin-angiotensin system (RAS) activation after cardiac surgery is linked to acute kidney injury (AKI). Urinary angiotensinogen (uAGT) may predict AKI occurrence and severity, suggesting RAS inhibition as a potential treatment.

Area of Science:

  • Nephrology
  • Cardiology
  • Surgical Science

Background:

  • Cardiac surgery with cardiopulmonary bypass is associated with acute kidney injury (AKI).
  • The role of the intrarenal renin-angiotensin system (RAS) in post-cardiac surgery AKI is not fully understood.
  • Intrarenal RAS activation may contribute to the decline in renal function following these procedures.

Purpose of the Study:

  • To investigate the influence of intrarenal RAS activation on renal function decrease in patients undergoing cardiac surgery.
  • To determine if urinary angiotensinogen (uAGT) can serve as a biomarker for predicting AKI after cardiac surgery.
  • To explore the potential of inhibiting intrarenal RAS as a therapeutic strategy.

Main Methods:

  • Observational study involving 24 patients with AKI and 21 controls without AKI after cardiac surgery.
  • Measurement of urinary angiotensinogen (uAGT) at baseline, and 0 and 12 hours post-surgery.
  • Collection of clinical and laboratory data to assess renal function and patient outcomes.

Main Results:

  • All patients exhibited intrarenal RAS activation post-surgery.
  • Patients who developed AKI showed significantly higher uAGT levels at 0 and 12 hours post-surgery compared to the non-AKI group.
  • A positive correlation was observed between RAS activation at 0 hours and the decrease in renal function at 48 hours (r=0.654, P=.001).

Conclusions:

  • Intrarenal RAS activation is significantly elevated in patients developing AKI after cardiac surgery.
  • Urinary angiotensinogen (uAGT) shows promise as a predictive biomarker for AKI occurrence and severity.
  • Targeting intrarenal RAS activation may represent a future therapeutic avenue for preventing or treating post-cardiac surgery AKI.

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