Title:Nephrotic Syndrome and Renin-angiotensin System: Pathophysiological
Role and Therapeutic Potential
Volume: 16
Author(s): Alessandra Aguiar dos Anjos, Isadora Tucci de Paiva, Giovanna Letícia Simões Lima, Roberta da Silva Filha, Brunna Pinto E. Fróes, Sérgio Veloso Brant Pinheiro and Ana Cristina Simões E. Silva*
Affiliation:
- Departamento de Pediatria, Faculdade de Medicina, Unidade de Nefrologia Pediátrica, Universidade Federal de Minas
Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
- Faculdade de Medicina, Laboratório Interdisciplinar de Investigação
Médica, UFMG, Belo Horizonte, Minas Gerais, Brazil
Keywords:
ACE2, renin-angiotensin system, steroid-resistant nephrotic syndrome, idiopathic nephrotic syndrome, angiotensin- (1-7), mas receptor agonists, chronic kidney disease.
Abstract: Idiopathic Nephrotic Syndrome (INS) is the most frequent etiology of glomerulopathy
in pediatric patients and one of the most common causes of chronic kidney disease (CKD) and
end-stage renal disease (ESRD) in this population. In this review, we aimed to summarize evidence
on the pathophysiological role and therapeutic potential of the Renin-Angiotensin System
(RAS) molecules for the control of proteinuria and for delaying the onset of CKD in patients
with INS. This is a narrative review in which the databases PubMed, Web of Science, and Sci-
ELO were searched for articles about INS and RAS. We selected articles that evaluated the pathophysiological
role of RAS and the effects of the alternative RAS axis as a potential therapy for
INS. Several studies using rodent models of nephropathies showed that the treatment with activators
of the Angiotensin-Converting Enzyme 2 (ACE2) and with Mas receptor agonists reduces
proteinuria and improves kidney tissue damage. Another recent paper showed that the reduction
of urinary ACE2 levels in children with INS correlates with proteinuria and higher concentrations
of inflammatory cytokines, although data with pediatric patients are still limited. The molecules
of the alternative RAS axis comprise a wide spectrum, not yet fully explored, of potential
pharmacological targets for kidney diseases. The effects of ACE2 activators and receptor Mas
agonists show promising results that can be useful for nephropathies including INS.
