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Inappropriately high plasma renin activity accompanies chronic loss of renal function

N L Yeyati1, H J Adrogué

  • 1Renal Section, Hospital de Clinicas, Universidad de Buenos Aires, Argentina.

American Journal of Nephrology
|January 1, 1996
PubMed

Insights

Patients with chronic kidney disease show significantly elevated plasma renin activity (PRA) relative to their glomerular filtration rate (GFR). This inappropriate renin-angiotensin system activation may drive progressive renal injury.

Area of Science:

  • Nephrology
  • Cardiovascular Physiology
  • Renal Pathophysiology

Background:

  • The renin-angiotensin system (RAS) is implicated in experimental renal disease pathogenesis.
  • Excessive RAS activation in human chronic kidney disease (CKD) is not well-documented.
  • RAS plays a known role in the progression of renal damage.

Purpose of the Study:

  • To investigate plasma renin activity (PRA) and PRA/GFR ratio in CKD patients versus healthy controls.
  • To determine if RAS activation in CKD is inappropriately high.
  • To explore the relationship between RAS activation and sodium handling in CKD.

Main Methods:

  • Measured plasma renin activity (PRA) in normal volunteers and CKD patients.
  • Calculated the ratio of PRA to glomerular filtration rate (PRA/GFR).
  • Assessed the correlation between PRA/GFR and fractional excretion of sodium (FeNa).

Main Results:

  • CKD patients exhibited a tenfold higher PRA/GFR ratio compared to normal volunteers.
  • PRA/GFR was positively correlated with FeNa in CKD patients (r = 0.781, p < 0.01).
  • Normal controls showed a negative correlation between PRA/GFR and FeNa (r = -0.640, p < 0.01).

Conclusions:

  • Results support inappropriate activation of the renin-angiotensin system in human CKD.
  • This overstimulation may be a critical factor in advanced renal injury.
  • The findings challenge the notion that elevated PRA in CKD is solely due to sodium conservation.

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