Classic and Nonclassic Renin-Angiotensin Systems in the Critically Ill

Crit Care Clin. 2019 Apr;35(2):213-227. doi: 10.1016/j.ccc.2018.11.002. Epub 2019 Jan 28.

Abstract

Classic and nonclassic renin-angiotensin systems (RAS) are 2 sides of an ubiquitous endocrine/paracrine cascade regulating blood pressure and homeostasis. Angiotensin II and angiotensin-converting enzyme (ACE) levels are associated with severity of disease in the critically ill, and are central to the physiology and the pathogenesis of circulatory shock. Angiotensin (1-7) and ACE2 act as an endogenous counterregulatory arm to the angiotensin II/ACE axis. The tissue-based RAS has paracrine effects dissociated from those of the circulating RAS. Exogenous angiotensin II or ACE2 may improve the outcome of septic shock and acute respiratory distress syndrome, respectively.

Keywords: Acute kidney injury; Acute respiratory distress syndrome; Angiotensin; Angiotensin-converting enzyme; Inflammation; Renin; Sepsis; Septic shock.

Publication types

  • Review

MeSH terms

  • Acute Kidney Injury / drug therapy*
  • Acute Kidney Injury / physiopathology
  • Adult
  • Aged
  • Aged, 80 and over
  • Angiotensin I / therapeutic use*
  • Angiotensin II / therapeutic use*
  • Blood Pressure / physiology
  • Critical Illness
  • Female
  • Homeostasis / physiology
  • Humans
  • Male
  • Middle Aged
  • Peptide Fragments / therapeutic use*
  • Renin-Angiotensin System / physiology*
  • Respiratory Distress Syndrome / drug therapy*
  • Respiratory Distress Syndrome / physiopathology
  • Shock, Septic / drug therapy*
  • Shock, Septic / physiopathology
  • Vasoconstrictor Agents / therapeutic use*

Substances

  • Peptide Fragments
  • Vasoconstrictor Agents
  • Angiotensin II
  • Angiotensin I
  • angiotensin I (1-7)