DOCSLIB.ORG

REVIEW the Renin–Angiotensin System in Thyroid Disorders and Its

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
REVIEW the Renin–Angiotensin System in Thyroid Disorders and Its 25 REVIEW The renin–angiotensin system in thyroid disorders and its role in cardiovascular and renal manifestations Fe´lix Vargas, Isabel Rodrı´guez-Go´mez, Pablo Vargas-Tendero, Eugenio Jimenez1 and Mercedes Montiel1 Departamento de Fisiologı´a, Facultad de Medicina, Universidad de Granada, E-18012 Granada, Spain 1Departamento de Bioquı´mica y Biologı´a Molecular e Inmunologı´a, Facultad de Medicina, Universidad de Ma´laga, Boulevard Louis Pasteur 32, 29071 Ma´laga, Spain (Correspondence should be addressed to F Vargas; Email: [email protected]) Abstract Thyroid disorders are among the most common endocrine while RAS components act systemically and locally in diseases and affect virtually all physiological systems, with an individual organs. Various authors have implicated the especially marked impact on cardiovascular and renal systems. systemic and local RAS in the mediation of functional and This review summarizes the effects of thyroid hormones on structural changes in cardiovascular and renal tissues due to the renin–angiotensin system (RAS) and the participation of abnormal thyroid hormone levels. This review analyzes the the RAS in the cardiovascular and renal manifestations of influence of thyroid hormones on RAS components and thyroid disorders. Thyroid hormones are important regulators discusses the role of the RAS in BP, cardiac mass, vascular of cardiac and renal mass, vascular function, renal sodium function, and renal abnormalities in thyroid disorders. handling, and consequently blood pressure (BP). The RAS Journal of Endocrinology (2012) 213, 25–36 acts globally to control cardiovascular and renal functions, Thyroid hormones and the renin–angiotensin important role in the function of these organs and is involved system in cell growth, angiogenesis, proliferation, among others. The local RAS appears to be regulated independently from the Classically, the renin–angiotensin system (RAS) consists of a circulating system in a specific manner according to the cell cascade of reactions in which angiotensinogen, substrate of type and extracellular stimulus, although it can interact with the RAS, is cleaved by renin released into the circulation to and complement the circulating system. An intracellular RAS generate the decapeptide angiotensin I (AI). The peptidyl- was recently reported, characterized by the presence of a dipeptidase angiotensin-converting enzyme (ACE), a complete functionally active RAS within the cell that can membrane-bound metalloprotease primarily present on synthesize AII in an independent manner (Kumar et al. 2007). endothelial cells, converts AI to the octapeptide angiotensin II Hence, the RAS is a paracrine and intracrine system as well as (AII). AII is the most active known peptide of the RAS and an endocrine system (Fyhrquist & Saijonmaa 2008). acts on various tissues in the body via selective binding to two Recognition of the important role of intracellular RAS in major subtypes of G-protein-coupled receptors: AII type 1 the cardiovascular system has grown over the past few (AT1) and type 2 (AT2) receptors. The role of the RAS in decades, with observations that the heart, vascular smooth blood pressure (BP) control is well documented, but it is also muscle cells (VSMCs), and fibroblasts can intracellularly involved in the local regulation of numerous functions and generate the vasoactive peptide AII. can be influenced by different stimuli and hormones, Thyroid hormones play an important role in BP control including thyroid hormones. but can exert many other effects on the cardiovascular system, The RAS is more complex than originally thought, and both hypo- and hyperthyroidism can cause cardiovascular because it operates not only as a circulating endocrine system dysfunction (Klein & Ojamaa 1995, 2001, Vargas et al. 2006, but also as a local tissue system (Dzau & Herrmann 1982) Ichiki 2010). Thyroid hormones are known to increase the that has been identified in most organs and tissues studied response of tissues to the action of the sympathetic system, (e.g. heart, blood vessels, kidney, adrenal gland, pancreas, and this may be a mechanism by which they regulate BP. CNS, reproductive system, and fatty tissues). It plays an However, thyroid hormones can also activate the RAS Journal of Endocrinology (2012) 213, 25–36 DOI: 10.1530/JOE-11-0349 0022–0795/12/0213–025 q 2012 Society for Endocrinology Printed in Great Britain Online version via http://www.endocrinology-journals.org Downloaded from Bioscientifica.com at 10/01/2021 02:40:11PM via free access 26 F VARGAS and others . Renin–angiotensin system in thyroid disorders without involving the sympathetic nervous system (Kobori have demonstrated the influence of thyroid hormones on et al. 2001). circulating renin. Experimental hyperthyroidism produces an Numerous studies have been performed to characterize the increase in plasma renin activity (PRA) and plasma renin physiological role of thyroid hormones in controlling the concentration (PRC), while the induction of hypothyroidism synthesis and secretion of RAS components (Jime´nez et al. in adult rats reduces PRA and PRC (Hauger-Klevene & 1982, Montiel et al. 1987, Carneiro-Ramos et al. 2006, Diniz Levin 1976, Jime´nez et al. 1982). However, different results et al. 2009). Several in vivo and in vitro studies have reported were obtained when hypothyroidism was induced by surgical that thyroid hormones might modulate the RAS and have thyroidectomy in rats in the first day of life, when an increase evidenced a relationship between the thyroid state and RAS in renal renin content (Bouhnik et al. 1981) and PRC components at both plasma and tissue levels (Kumar et al. (Jime´nez et al. 1984) was observed, suggesting the operation 2008, Barreto-Chaves et al. 2010). Thyroid hormones play a of distinct mechanisms according to the age at which the major role in the growth and development of various tissues, thyroid hormone deficit is produced. including the kidney and lung, which are major sites of renin In vitro studies indicated that thyroid hormones influence and ACE synthesis; therefore, thyroid hormone deficiency in the synthesis and secretion of renin by juxtaglomerular early developmental stages can have significant effects on RAS cells. Ichihara et al. (1998) found that triiodothyronine (T3) components (Chen et al. 2005). In this study, we review the administration increases renin secretion, renin content, and effects of a deficit or excess of thyroid hormones on RAS renin mRNA in rat juxtaglomerular cell cultures. Various components (Table 1). authors observed this direct action in cardiac tissue from hyperthyroid rats and reported that thyroid hormones directly stimulate renin mRNA and the promoter activity of the Renin human renin gene via thyroid hormone regulating element- Since the discovery of renin 100 years ago, various tissues have dependent mechanisms (Gilbert et al. 1994, Kobori et al. been found to express the renin gene, although the main 1997a,b, 2001). These actions of thyroid hormones on renin source of circulating renin production is located in secretion and renin mRNA are direct and not mediated by juxtaglomerular kidney cells (Kurtz 2011). Renin is an changes in sympathetic nervous system activity (Kobori et al. aspartyl protease that cleaves AI decapeptide from the 1997a,b). However, the above studies do not rule out the angiotensinogen molecule, and numerous in vivo studies possibility that RAS activity modifications in thyroid Table 1 Plasma and local renin–angiotensin compounds in thyroid hormone excess or deficit Compound Hyperthyroidism Hypothyroidism Plasma Angiotensinogen [ (Dzau & Herrmann 1982, Marchant et al. 1993); Y (Bouhnik et al. 1981, Jime´nez et al. 1982, Y (Jime´nez et al. 1982) Katz 2003) Renin [ (Hauger-Klevene & Levin 1976, Jime´nez et al. [ (Jime´nez et al. 1984); Y (Hauger-Klevene & 1982, Santos & Ferreira 2007) Levin 1976, Jime´nez et al. 1982) Angiotensin-converting enzyme [ (Phillips et al. 1993) Y (Montiel et al. 1987, Jime´nez et al. 1990) Angiotensin II [ (Marchant et al. 1993, Garcia del Rı´o et al. Y (Marchant et al. 1993, Kobori et al. 1997a,b) 1997, Kobori et al. 1997a,b) New RAS components – – Heart Renin [ (Kobori et al. 1997a,b)– Angiotensin II [ (Kobori et al. 1997a,b, 1999, Diniz et al. 2007) Z (Carneiro-Ramos et al. 2007) / Y Z [ AT1R (Carneiro-Ramos et al. 2010); (Marchant (Marchant et al. 1993); (Carneiro-Ramos et al. 1993) et al. 2007) [ [ AT2R (Marchant et al. 1993, Carneiro-Ramos (Marchant et al. 1993, Carneiro-Ramos et al. 2010) et al. 2007) Kidney Renin [ (Bouhnik et al. 1981, Kobori et al. 1997a,b, Y (Kobori et al. 1997a,b) Klein & Ojamaa 2001) Angiotensin II [ (Klein & Ojamaa 2001)– Y AT1R– (Chen et al. 2005) [ AT2R– (Chen et al. 2005) Vessels Renin – – Angiotensin II – – Y AT1R (Fukuyama et al. 2003)– [ AT2R (Barreto-Chaves et al. 2010)– F, Forward; R, reverse. Journal of Endocrinology (2012) 213, 25–36 www.endocrinology-journals.org Downloaded from Bioscientifica.com at 10/01/2021 02:40:11PM via free access Renin–angiotensin system in thyroid disorders . F VARGAS and others 27 disorders in vivo may be in part mediated by changes in ACE activity is influenced by thyroid dysfunction at b-adrenergic activity. In fact, an increased number of both circulating and tissue levels. Reduced serum and liver b-adrenergic receptors were found in the renal cortex in ACE concentrations were reported in neonatal rats with experimental hyperthyroidism (Haro et al. 1992), and PRA is hypothyroidism induced by maternal administration of enhanced by b-adrenergic
Load more

Recommended publications
  • Why Is Plasma Renin Activity Lower in Populations of African Origin?
    Journal of Human Hypertension (2001) 15, 17–25 2001 Macmillan Publishers Ltd All rights reserved 0950-9240/01 $15.00 www.nature.com/jhh REVIEW ARTICLE Why is plasma renin activity lower in populations of African origin? GA Sagnella Blood Pressure Unit, St George’s Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK Plasma renin activity is significantly lower in black the molecular level suggests that the lower PRA may people compared with whites independent of age and arise from gene variation in the renal epithelial sodium blood pressure status. The lower PRA appears to be due channel. The functional significance of the lower PRA in to a reduction in the rate of secretion of renin but the relation to the different pattern of cardiovascular and exact mechanistic events underlying such differences in renal disease between blacks and whites remains renin release between blacks and whites are still not unclear. Moreover, direct investigations of pre-treat- fully understood. Nevertheless, given the paramount ment renin status in hypertensive blacks in relation to importance of the renin-angiotensin system in the con- blood pressure response have demonstrated that the trol of sodium balance, a most likely explanation is that pre-treatment PRA is not a good index of subsequent the lower renin is a consequence of differences in renal blood pressure response to pharmacological treatment. sodium handling between blacks and whites. The lower Nevertheless, the blood pressure reduction to short PRA does not reflect differences in dietary sodium term sodium restriction is greater in blacks compared intake but the evidence available suggests that the low with whites and, in the black subjects, the greater PRA could be part of the corrective mechanisms reduction in blood pressure to sodium restriction designed to maintain sodium balance in the presence appears to be related, at least in part, to the decreased of an increased tendency for sodium retention in black responsiveness of the renin-angiotensin system.
    [Show full text]
  • Aldosterone-Renin Ratio (Arr)
    RENIN -ALDOSTERONE PROFILING: ALDOSTERONE-RENIN RATIO (ARR) 1. Obtain a morning specimen for serum aldosterone (redtop tube) and plasma renin (lavender-top) tube from an upright patient sitting for a period of 15 min prior to (being seated for) blood drawing. Fasting is not required and no salt restriction is necessary. 2. Spironolactone. The ratio cannot be assessed in patients receiving spironlactone. If primary aldosteronism (PA) is suspected in a patient receiving this drug, treatment should be discontinued for 4-6 weeks (1). 3. Hypokalemia should be corrected before ARR is measured as a low K will lower aldosterone and can lead to a falsely negative ARR (1). 4. Preferred antihypertensives that have a minimal effect on the ARR are doxazozin (Cardura), prazosin (Minipress), verapramil slow release, or hydralazine, singly or in combination for one month before sampling (1). 5. False-positive ARR: Beta-blockers, clonidine, methyldopa, and NSAID’s lower levels of renin and can cause a falsely positive ARR (1). A minimum 3-day cessation prior to sampling is recommended (3). The renin direct assay is also lower in patients on oral contraceptives and hormone replacement therapy potentially causing the ARR to be falsely increased. Measurement of plasma renin activity is preferred in this situation, calculating the aldosterone/PRA ratio (positive if >20/1). 6. False-negative ARR: Diuretics cause false negatives by causing K loss lowering aldosterone and stimulating renin through volume loss. Angiotensin blockers (ARB’s), ACE inhibitors, and some calcium channel blockers raise renin and can cause false negatives (1). A minimum three-day cessation prior to sampling is recommended (3).
    [Show full text]
  • Plasma Renin Activity and Pro-B-Type Natriuretic Peptide Levels in Different Atrial Fibrillation Types
    Original Investigation Özgün Araşt›rma 317 Plasma renin activity and pro-B-type natriuretic peptide levels in different atrial fibrillation types Farklı atriyal fibrilasyon türlerinde plazma renin aktivitesi ve pro-B-tipi natriüretik peptit düzeyleri Abdullah Doğan, Ömer Gedikli1, Mehmet Özaydın, Gürkan Acar2 Department of Cardiology, Faculty of Medicine, Süleyman Demirel University, Isparta 1Department of Cardiology, Faculty of Medicine, Karadeniz Technical University, Trabzon 2Department of Cardiology, Faculty of Medicine, Sütçü Imam University, Kahramanmaraş, Turkey ABSTRACT Objective: Renin-angiotensin system may be activated during atrial fibrillation (AF). Our aim was to evaluate plasma renin activity (PRA) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in patients with different AF types who had normal left ventricular (LV) systolic function. Methods: This cross-sectional study included 97 patients with recent (≤7 days), persistent (7 days to 12 months) and permanent AF (>12 months), and age- and sex-matched 30 controls with sinus rhythm. Plasma levels of PRA and NT-pro-BNP were measured and presented as median (25th-75th percentiles). Echocardiographic examination was performed in all population. Variance and logistic regression analyses were also used for multiple comparisons and independent predictors, respectively. Results: Median NT-proBNP levels were higher in overall patients with AF than in controls [114 (63-165) vs 50 (38-58) pg/ml, p<0.001), but PRA level was comparable in both groups. Similarly, NT-proBNP levels were also higher in all subtypes of AF compared with controls (p<0.05). In addition, there was a significant difference in NT-proBNP level among recent, persistent and permanent AF subtypes (p=0.001).
    [Show full text]
  • Effects of Moxonidine on the Sympathetic Nervous System
    Journal of Clinical and Basic Cardiology An Independent International Scientific Journal Journal of Clinical and Basic Cardiology 2004; 7 (1-4), 19-25 Effects of Moxonidine on the Sympathetic Nervous System, Blood Pressure, Plasma Renin Activity, Plasma Aldosterone, Leptin, and Metabolic Profile in Obese Hypertensive Patients Sanjuliani AF, Francischetti EA, Genelhu de Abreu V Ueleres Braga J Homepage: www.kup.at/jcbc Online Data Base Search for Authors and Keywords Indexed in Chemical Abstracts EMBASE/Excerpta Medica Krause & Pachernegg GmbH · VERLAG für MEDIZIN und WIRTSCHAFT · A-3003 Gablitz/Austria ORIGINAL PAPERS, CLINICAL CARDIOLOGY Moxonidine in Obese Hypertensive Patients J Clin Basic Cardiol 2004; 7: 19 Effects of Moxonidine on the Sympathetic Nervous System, Blood Pressure, Plasma Renin Activity, Plasma Aldosterone, Leptin, and Metabolic Profile in Obese Hypertensive Patients A. F. Sanjuliani, V. Genelhu de Abreu, J. Ueleres Braga, E. A. Francischetti Obesity accounts for around 70 % of the patients with primary hypertension. This association accentuates the risk of cardiovascular disease as it is frequently accompanied by the components of the metabolic syndrome. Clinical, epidemiological and experimental studies show an association between obesity-hypertension with insulin resistance and increased sympathetic nervous system activity. We conducted the present study to evaluate in forty obese hypertensives of both genders, aged 27 to 63 years old, the chronic effects of moxonidine – a selective imidazoline receptor agonist – on blood pressure, plasma catecholamines, leptin, renin-angiotensin aldosterone system and components of the metabolic syndrome. It was a randomized parallel open study, amlodipine was used as the control drug. Our results show that moxonidine and amlodipine significantly reduced blood pressure without affecting heart rate when measured by the oscillometric method and with twenty-four-hour blood pressure monitoring.
    [Show full text]
  • Roles of the Circulating Renin-Angiotensin-Aldosterone System in Human Pregnancy
    Am J Physiol Regul Integr Comp Physiol 306: R91–R101, 2014. First published October 2, 2013; doi:10.1152/ajpregu.00034.2013. Review Roles of the circulating renin-angiotensin-aldosterone system in human pregnancy Eugenie R. Lumbers and Kirsty G. Pringle School of Biomedical Sciences and Pharmacy and Mothers and Babies Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia Submitted 24 January 2013; accepted in final form 2 October 2013 Lumbers ER, Pringle KG. The roles of the circulating renin-angiotensin-aldosterone system in human pregnancy. Am J Physiol Regul Integr Comp Physiol 306: R91–R101, 2014. First published October 2, 2013; doi:10.1152/ajpregu.00034.2013.—This review describes the changes that occur in circulating renin-angiotensin-aldosterone sys- tem (RAAS) components in human pregnancy. These changes depend on endo- crine secretions from the ovary and possibly the placenta and decidua. Not only do these hormonal secretions directly contribute to the increase in RAAS levels, they also cause physiological changes within the cardiovascular system and the kidney, which, in turn, induce reflex release of renal renin. High levels of ANG II play a critical role in maintaining circulating blood volume, blood pressure, and uteropla- cental blood flow through interactions with the ANG II type I receptor and through increased production of downstream peptides acting on a changing ANG receptor phenotype. The increase in ANG II early in gestation is driven by estrogen-induced increments in angiotensinogen (AGT) levels, so there cannot be negative feedback leading to reduced ANG II production. AGT can exist in various forms in terms of redox state or complexed with other proteins as polymers; these affect the ability of renin to cleave ANG I from AGT.
    [Show full text]
  • Redalyc.Feline Primary Hyperaldosteronism: an Emerging
    Ciência Rural ISSN: 0103-8478 [email protected] Universidade Federal de Santa Maria Brasil Diola Bento, Daniel; Soares Zahn, Fabíola; Duarte, Laura Carolina; de Araújo Machado, Luiz Henrique Feline primary hyperaldosteronism: an emerging endocrine disease Ciência Rural, vol. 46, núm. 4, abril, 2016, pp. 686-693 Universidade Federal de Santa Maria Santa Maria, Brasil Available in: http://www.redalyc.org/articulo.oa?id=33144324020 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative Ciência Rural, Santa Maria, v.46, n.4,Feline p.686-693, primary abr, hyperaldosteronism: 2016 an emerging endocrine http://dx.doi.org/10.1590/0103-8478cr20141327 disease. 686 ISSN 1678-4596 CLINIC AND SURGERY Feline primary hyperaldosteronism: an emerging endocrine disease Hiperaldosteronismo primário felino: uma enfermidade endócrina emergente Daniel Diola BentoI Fabíola Soares ZahnII Laura Carolina DuarteIII Luiz Henrique de Araújo MachadoIV – REVIEW – ABSTRACT aumento da excreção de potássio, que ocasionarão, respectivamente, hipertensão arterial sistêmica e hipocalemia grave. O diagnóstico The primary hyperaldosteronism, an endocrine é realizado com base na comprovação da hipersecreção hormonal disease increasingly identified in cats, is characterized by adrenal com supressão da liberação de renina, além de exames de imagem gland dysfunction that interferes with the renin-angiotensin- e avaliação histopatológica da adrenal. O tratamento pode ser aldosterone system, triggering the hypersecretion of aldosterone. curativo, com a adrenalectomia, em enfermidades unilaterais, Pathophysiological consequences of excessive aldosterone ou conservativo, por meio de antagonistas da aldosterona, secretion are related to increased sodium and water retention, suplementação de potássio e anti-hipertensivos.
    [Show full text]
  • Opposite Associations of Circulating Aldosterone and Atrial Natriuretic Peptide with Left Ventricular Diastolic Function in Essential Hypertension
    Journal of Human Hypertension (1998) 12, 195–202 1998 Stockton Press. All rights reserved 0950-9240/98 $12.00 ORIGINAL ARTICLE Opposite associations of circulating aldosterone and atrial natriuretic peptide with left ventricular diastolic function in essential hypertension RH Fagard, PJ Lijnen and VV Petrov Hypertension and Cardiovascular Rehabilitation Unit, Department of Molecular and Cardiovascular Research, Faculty of Medicine, University of Leuven KU Leuven, Leuven, Belgium It has been shown in animal experiments that angioten- (P Ͻ 0.001) and to plasma aldosterone (P Ͻ 0.01), and sin II and aldosterone have mitogenic effects on the car- positively to plasma atrial natriuretic peptide (P Ͻ 0.05). diovascular system, whereas atrial natriuretic peptide Peak flow velocity during atrial contraction was posi- has antimitogenic properties. The aim of the present tively related to plasma atrial natriuretic peptide both study was to relate plasma renin activity, angiotensin II, before (P Ͻ 0.001) and after (P Ͻ 0.05) controlling for aldosterone and atrial natriuretic peptide to left ventricu- significant covariates (age, sex and blood pressure). We lar structure and function, assessed by use of imaging conclude that circulating renin, angiotensin II, aldos- echocardiography and transmitral Doppler velocimetry terone and atrial natriuretic peptide are not indepen- in 73 patients with essential hypertension, World Health dently related to left ventricular mass in essential hyper- Organization stages I–II, aged 43 ؎ 10 (s.d.) years. Left tension. The inverse association of plasma aldosterone ventricular mass, wall thickness and internal diameter with indices of diastolic function is compatible with a were not independently related to the biochemical vari- stimulating effect of aldosterone on myocardial fibrosis, ables, except for a weak and positive association of wall which is opposed by atrial natriuretic peptide.
    [Show full text]
  • Endocrine and Electrolyte Balances During Periovulatory Period in Cycling Mares
    animals Article Endocrine and Electrolyte Balances during Periovulatory Period in Cycling Mares Katiuska Satué 1,* , Esterina Fazio 2 , Ana Muñoz 3 and Pietro Medica 2 1 Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, CEU-Cardenal Herrera University, 46115 Valencia, Spain 2 Department of Veterinary Sciences, Veterinary Physiology Unit, Polo Universitario Annunziata, Viale Palatucci 13, 98168 Messina, Italy; [email protected] (E.F.); [email protected] (P.M.) 3 Department of Animal Medicine and Surgery, School of Veterinary Medicine, University of Córdoba, 14014 Córdoba, Spain; [email protected] * Correspondence: [email protected]; Tel.: +96-136-900066020 Simple Summary: This study provides new evidence on the physiological mechanisms involved in the electrolyte balance during periovulatory period in cycling mares. The interrelationships among adrenocorticotropic hormone (ACTH), cortisol (CORT), aldosterone (ALD) and electrolytes (sodium—Na+, potassium—K+ and chloride—Cl−) were evaluated. The simultaneous increase in ACTH, CORT and ALD toward the time of ovulation could suggest the involvement of the adrenocortical pituitary axis in the ovulatory mechanisms, contributing at the same time to the maintenance of electrolyte homeostasis. Abstract: In cycling females, the periovulatory period is characterized by stimulation of the hy- pothalamic pituitary adrenal (HPA) axis. The aim of present study was to analyze the pattern and interrelationships among adrenocorticotropic hormone (ACTH), cortisol (CORT), aldosterone (ALD) and electrolytes (sodium—Na+, potassium—K+ and chloride—Cl−) during periovulatory period in cycling mares. Venous blood samples were obtained daily from a total of 23 Purebred Spanish broodmares, aged 7.09 ± 2.5 years, from day −5 to day +5 of estrous cycle, considering day 0, the Citation: Satué, K.; Fazio, E.; day of ovulation.
    [Show full text]
  • Lab Dept: Chemistry Test Name: RENIN
    Lab Dept: Chemistry Test Name: RENIN General Information Lab Order Codes: REN Synonyms: Plasma Renin Activity CPT Codes: 84244 - Renin Test Includes: Plasma renin activity measured in ng/mL/hour. Logistics Test Indications: Investigation of primary aldosteronism (e.g., adrenal adenoma/carcinoma and adrenal cortical hyperplasia) and secondary aldosteronism (renovascular disease, salt depletion, potassium loading, cardiac failure with ascites, pregnancy, Bartter’s syndrome). Lab Testing Sections: Chemistry - Sendouts Referred to: Mayo Medical Laboratories (Test# 8060/PRA) Phone Numbers: MIN Lab: 612-813-6280 STP Lab: 651-220-6550 Test Availability: Daily, 24 hours Turnaround Time: 2 - 5 days, set up Monday - Friday Special Instructions: See Patient Preparation Specimen Specimen Type: Whole blood Container: Chilled syringe and transfer to a chilled Lavender top (EDTA) tube placed in an ice bath for transport to the lab Draw Volume: 6 mL (Minimum: 4 mL) blood Processed Volume: 2 mL (Minimum: 1.2 mL) plasma Collection: Routine venipuncture using a chilled syringe. Transfer specimen into a chilled Lavender top tube. Mix chilled lavender top tube gently by inversion and place in an ice-water bath. Transport promptly to laboratory. Special Processing: Lab Staff: Do Not leave blood at room temperature. Centrifuge for approximately 5 minutes in a refrigerated centrifuge. Remove plasma aliquot into a screw-capped round bottom plastic vial and freeze immediately. Ship frozen. Forward promptly. Patient Preparation: Patient should be in a seated position for the specimen draw. Sample Rejection: Clotted sample or any specimen other than EDTA plasma; gross hemolysis; mislabeled or unlabeled specimens Interpretive Reference Range: Age: Result in ng/mL/hour 0 – 2 years: 4.6 (mean*) 3 – 5 years: 2.5 (mean*) 6 – 8 years: 1.4 (mean*) 9 – 11 years: 1.9 (mean*) 12 – 17 years: 1.8 (mean*) *Mean data not standardized as to time of day or diet.
    [Show full text]
  • Involvement of ACE2/Ang-(1-7)/MAS1 Axis in the Regulation of Ovarian Function in Mammals
    International Journal of Molecular Sciences Review Involvement of ACE2/Ang-(1-7)/MAS1 Axis in the Regulation of Ovarian Function in Mammals Kamila Domi ´nska Department of Comparative Endocrinology, Medical University of Lodz, Zeligowskiego 7/9, 90-752 Lodz, Poland; [email protected]; Tel.: +48-426393180 Received: 1 June 2020; Accepted: 22 June 2020; Published: 27 June 2020 Abstract: In addition to the classic, endocrine renin-angiotensin system, local renin-angiotensin system (RAS) has been documented in many tissues and organs, including the ovaries. The localization and functional activity of the two opposing axes of the system, viz. ACE1/Ang II/AT1 and ACE2/Ang-(1-7)/MAS1, differs between animal species and varied according to the stage of follicle development. It appears that the angiotensin peptides and their receptors participate in reproductive processes such as folliculogenesis, steroidogenesis, oocyte maturation, and ovulation. In addition, changes in the constituent compounds of local RAS may contribute to pathological conditions, such as polycystic ovary syndrome, ovarian hyperstimulation syndrome, and ovarian cancer. This review article examines the expression, localization, metabolism, and activity of individual elements of the ACE2/Ang-(1-7)/MAS1 axis in the ovaries of various animal species. The manuscript also presents the relationship between the secretion of gonadotropins and sex hormones and expression of Ang-(1-7) and MAS1 receptors. It also summarizes current knowledge regarding the positive and negative impact of ACE2/Ang-(1-7)/MAS1 axis on ovarian function. Keywords: RAS; angiotensin-(1-7); MAS; ACE; ovary; folliculogenesis; polycystic ovary; hyperstimulation; ovarian cancer 1. Introduction Ovaries are female gonads responsible for the production of sex cells (oocytes) and the synthesis of hormones necessary for regulation of reproductive functions.
    [Show full text]
  • Comparison of Active Renin Concentration and Plasma Renin
    European Journal of Endocrinology (2004) 150 517–523 ISSN 0804-4643 CLINICAL STUDY Comparison of active renin concentration and plasma renin activity for the diagnosis of primary hyperaldosteronism in patients with an adrenal mass Nicole Unger1, Ingo Lopez Schmidt1, Christian Pitt4, Martin K Walz4, Thomas Philipp2, Klaus Mann1,3 and Stephan Petersenn1 1 Division of Endocrinology, Medical Center, 2 Division of Nephrology and Hypertension, Medical Center, 3 Department of Clinical Chemistry, University of Essen and 4 Department of Surgery and Centre of Minimally Invasive Surgery, Kliniken Essen-Mitte, Essen, Germany (Correspondence should be addressed to S Petersenn, Division of Endocrinology, Medical Center, University of Essen, Hufelandstr. 55, 45122 Essen, Germany; Email: [email protected]) Abstract Objective: Plasma aldosterone concentration (PAC) to plasma renin activity (PRA) ratio is an established screening test for primary hyperaldosteronism. Due to the increased recognition of adrenal incidentalomas, reliable parameters are required. Determination of active renin concentration (ARC) in contrast to PRA offers advantages with regard to processing and standardization. The present study compared PRA and ARC under random conditions to establish thresholds for the diagnosis of primary hyperaldosteronism. Design and methods: Fifty patients with various adrenal tumors, including ten patients with aldo- sterone-secreting adrenal adenomas, as well as ten hypertensive patients and 23 normotensive volunteers were studied. PAC and PRA were measured by radioimmunoassay. ARC was determined by an immunoluminometric assay. Results: Receiver operating curve (ROC) analysis suggested a PAC to ARC ratio threshold of 90 ((ng/l)/(ng/l)) (sensitivity 100%, specificity 98.6%) and a ratio threshold of 62 by additional consider- ation of PAC $200 ng/l (sensitivity 100%, specificity 100%) for the diagnosis of aldosterone-secreting adrenal adenomas.
    [Show full text]
  • Plasma Renin Activity (PRA) ELISA, IB59131 (RUO) | IBL-America
    direct arteriolar vasoconstriction, promoting sodium retention, and stimulating the secretion of aldosterone PLASMA RENIN ACTIVITY (PRA) ELISA from the adrenal cortex. Aldosterone also exerts an effect to restore sodium balance and lift arterial pressure. Accurate determination of the concentration of circulating angiotensin-II is challenging because of its instability in blood samples. PROCEDURAL CAUTIONS AND WARNINGS Cat. No.: IB59131 Version: 6.0 Effective: September 13, 2018 1. Users should have a thorough understanding of this protocol for the successful use of this kit. Reliable INTENDED USE performance will only be attained by strict and careful adherence to the instructions provided. For the determination of Plasma Renin Activity (PRA) in human plasma by an enzyme immunoassay. For 2. Ang-I is presently not included in any external QC schemes. Therefore, each laboratory is suggested to research use only, not for use in diagnostic procedures. establish its own internal QC materials and procedure for assessing the reliability of results. 3. When the use of water is specified for dilution or reconstitution, use deionized or distilled water. PRINCIPLE OF THE TEST 4. All kit reagents and specimens should be at room temperature and mixed gently but thoroughly before This kit measures PRA and the results are expressed in terms of mass of angiotensin-I (Ang-I) generated use. Avoid repeated freezing and thawing of reagents and plasma specimens. per volume of human plasma in unit time (ng/mL.h). 5. A calibrator curve must be established for every run. The kit controls should be included in every run and The blood sample is collected in a tube that contains EDTA.
    [Show full text]