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Related Concept Videos

Antihypertensive Drugs: Angiotensin-Converting Enzyme Inhibitors01:30

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Angiotensin-converting enzyme (ACE), a vital component of the renin-angiotensin-aldosterone system, is abundant in lung endothelial cells. ACE converts the inactive decapeptide, angiotensin I, into the active octapeptide, angiotensin II. This potent vasoconstrictor narrows blood vessels, increasing resistance to blood flow and elevating blood pressure. Angiotensin II also stimulates aldosterone production, encouraging kidney cells to reabsorb more sodium and water from urine, thereby increasing...
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In the renin-angiotensin-aldosterone system, a hormone called angiotensin II plays a crucial role. It binds to the AT1 receptors in vascular smooth muscles coupled with Gq proteins. The activation of these receptors activates an enzyme called phospholipase C, which releases two molecules: inositol trisphosphate and diacylglycerol. These molecules cause a chain reaction that leads to the phosphorylation of myosin light chains and promotes interaction between actin and myosin, leading to smooth...
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Antihypertensive Drugs: Direct Renin Inhibitors01:25

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The renin-angiotensin-aldosterone system (RAAS) is an intricate physiological pathway involving numerous enzymes and hormones, including renin, angiotensin-converting enzyme (ACE), angiotensin I and II, and aldosterone. Imbalances within this system increase the production of angiotensin II and aldosterone. Increased angiotensin II levels promote vasoconstriction and blood pressure elevation. Concurrently, higher aldosterone levels stimulate sodium and water reabsorption in the kidneys,...
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Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

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The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
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Renal Failure: Dose Adjustments01:11

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In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
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Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

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Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
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Related Experiment Video

Updated: Apr 13, 2026

Receptor Autoradiography Protocol for the Localized Visualization of Angiotensin II Receptors
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Kidney Protection Options in 2025: Are Renin-Angiotensin System Inhibitors Still Needed?

Matthew R Weir1

  • 1Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.

Seminars in Nephrology
|March 3, 2026
PubMed
Summary
This summary is machine-generated.

Angiotensin-converting enzyme inhibitors slow kidney disease progression, but many clinicians avoid them due to side effect concerns. Newer therapies may overshadow these established drugs in practice.

Keywords:
Kidney protectionhyperkalemianovel therapiesrenin-angiotensin system inhibition

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Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Angiotensin-converting enzyme (ACE) inhibitors, which modify the renin-angiotensin system (RAS), have demonstrated benefits in slowing kidney disease progression for over 40 years.
  • Despite proven efficacy in reducing cardiorenal events, consistent clinical use of RAS inhibitors is suboptimal.
  • Concerns regarding elevated serum creatinine and hyperkalemia limit the widespread adoption of these therapies.

Purpose of the Study:

  • To evaluate the current role and future prospects of renin-angiotensin system (RAS) inhibition in the multimodal management of chronic kidney disease (CKD) and cardiovascular events.
  • To address the clinical inertia surrounding RAS inhibitor use despite established benefits.

Main Methods:

  • Review of clinical trial data and established literature on RAS inhibitors and newer cardiorenal protective therapies.
  • Analysis of factors influencing clinical practice patterns regarding antihypertensive and cardiorenal protective medications.

Main Results:

  • RAS inhibitors are effective in slowing CKD progression and reducing cardiorenal events.
  • Clinician hesitancy stems from concerns about hyperkalemia and increased serum creatinine.
  • Newer therapies with potentially fewer side effects are emerging as alternatives or adjuncts.

Conclusions:

  • The optimal role of RAS inhibition in contemporary cardiorenal protection strategies requires re-evaluation.
  • As multimodal therapies advance, the foundational status of RAS inhibition may be challenged.
  • Further research and clinical guidance are needed to optimize the use of RAS inhibitors alongside newer agents.