Intrarenal Hormonal Regulation in Chronic Kidney Disease: A New Vision to Face its Treatment and Prevention

Abstract

Chronic Kidney Disease (CKD) is a worldwide health problem with an increasing prevalence and difficulty to diagnose. This has led to different research initiatives with objectives to study its causes and consequences. In this sense, in vivo experimental models have allowed us to characterize its physiopathology. This evolves from early inflammatory processes with hemodynamic alterations to an evident deterioration of renal function that is accompanied by the remodeling of the renal tissue. The Renin-Angiotensin-Aldosterone System (RAAS) has been described as the main hormonal system responsible for blood pressure control as well as hemodynamics variations. Moreover, the experimental studies in the last decade suggest that RAAS activation promotes inflammatory processes and immune responses that lead to renal damage. While RAAS components have traditionally been described at the systemic level, recent studies have revealed their
expression at the intrarenal level, where their regulation would occur differently to the systemic RAAS. Various studies, including our own from Chile, have shown that an increased activation of the intrarenal Renin-Angiotensin System (iRAS) would favor the CKD progression. Thus, related studies with iRAS regulation at early stages of CKD will provide new opportunities to improve our vision on both treatment and prevention.