Role of renin‐angiotensin system in acute kidney injury‐chronic kidney disease transition

• Published in: Nephrology (Carlton, Vic.) Vol. 23; no. S4; pp. 121 - 125
• Main Authors: Chou, Yu‐Hsiang, Chu, Tzong‐Shinn, Lin, Shuei‐Liong
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.10.2018; Wiley Subscription Services, Inc
• Subjects: acute kidney injury; Acute Kidney Injury - drug therapy; Acute Kidney Injury - epidemiology; Acute Kidney Injury - metabolism; Acute Kidney Injury - physiopathology; AKI‐CKD continuum; AKI‐CKD transition; Angiotensin; Angiotensin Receptor Antagonists - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Animals; chronic kidney disease; Disease Progression; Fibrosis; Humans; Kidney diseases; Kidneys; Recovery of function; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - metabolism; Renal Insufficiency, Chronic - physiopathology; Renal Insufficiency, Chronic - prevention & control; Renin; Renin-Angiotensin System - drug effects; renin‐angiotensin system; chronic kidney disease; acute kidney injury; renin-angiotensin system; AKI-CKD continuum; AKI-CKD transition
• ISSN: 1320-5358; 1440-1797
• DOI: 10.1111/nep.13467

ABSTRACT Acute kidney injury (AKI) can increase the risk of developing incident chronic kidney disease (CKD). The severity, frequency and duration of AKI are crucial predictors of poor renal outcome. A repair process after AKI can be adaptive and kidney recovers completely after a mild injury. However, severe injury will lead to a maladaptive repair, which frequently progresses to nephron loss, vascular rarefaction, chronic inflammation and fibrosis. Although different mechanisms underlying AKI‐CKD transition have been extensively discussed, no definite intervention has been proved effective to block or to retard the transition until recently. In CKD, renin‐angiotensin system (RAS) inhibitor has been proved effective to slow down disease progression. Furthermore, RAS needs to be highlighted again in AKI‐CKD transition because recent animal studies have shown the activation of intra‐renal RAS after AKI, and RAS blockade can reduce the ensuing CKD and mortality. In patients with the complete renal recovery after AKI, administration of RAS inhibitor is associated with reduced risk of subsequent CKD as well. In this article, we will demonstrate the role of RAS in AKI‐CKD transition comprehensively. We will then emphasize the promising effect of RAS inhibitor on CKD prevention in patients recovering from AKI based on evidence from the bench to clinical research. All of these discussions will contribute to the establishment of reliable monitoring and therapeutic strategies for patients with functional recovery from AKI who can be most easily ignored. Summary at a Glance Renin‐angiotensin system (RAS) is activated after AKI and leads to AKI‐CKD continuum. RAS blockade can reduce the ensuing CKD and mortality. Using RAS blockade could be considered for the monitoring and therapeutic strategies after AKI.