The effects of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in critically ill patients with acute kidney injury: An observational study using the MIMIC database

Zhu, Xu; Xue, Jing; Liu, Zheng; Dai, Wenjie; Xiang, Jingsha; Xu, Hui; Zhou, Qiaoling; Zhou, Quan; Wei, Xingmei; Chen, Wenhang

doi:10.3389/fphar.2022.918385

Cited by 5 publications

(6 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, Zhou et al [146] reported no significant association between perioperative use of renin-angiotensin system inhibitors and postoperative AKI in patients undergoing cardiac surgery. Other studies generally agree that ACEIs or ARBs increase survival, but also increase acute kidney disease, which is defined as persistent AKI from 7-90 days [73,74,147].…”

Section: Angiotensin II Inhibitorsmentioning

confidence: 99%

Reducing Oxygen Demand to Alleviate Acute Kidney Injury

Zhou¹

2023

Front. Biosci. (Landmark Ed)

View full text Add to dashboard Cite

Maintaining a balance between the supply and demand of oxygen is vital for proper organ function. Most types of acute kidney injury (AKI) are characterized by hypoxia, a state where the supply of oxygen cannot match the demand for normal cellular activities. Hypoxia results from hypo perfusion and impaired microcirculation in the kidney. It inhibits mitochondrial oxidative phosphorylation, resulting in a decrease in production of adenosine triphosphate (ATP), which is essential to power tubular transport activities, especially reabsorption of Na + , and other vital cellular activities. To ameliorate AKI, the majority of studies have focused on increasing renal oxygen delivery by restoring renal blood flow and altering intra-renal hemodynamics. However, to date these approaches remain inadequate. In addition to augmenting oxygen supply, increasing renal blood flow also increases glomerular filtration rate, leading to increased solute deliver and workload for the renal tubules, causing an increase in oxygen consumption. The relationship between Na + reabsorption and oxygen expenditure in the kidney is linear. Experimental models have demonstrated that inhibition of Na + reabsorption can alleviate AKI. Since the proximal tubules reabsorb approximately 65% of filtered Na + , consuming the largest portion of oxygen, many studies focus on examining the effects of inhibiting Na + reabsorption in this segment. Potential therapeutics that have been examined include acetazolamide, dopamine and its analog, inhibitors of the renin-angiotensin II system, atrial natriuretic peptide, and empagliflozin. The effectiveness of inhibition of Na + reabsorption in the thick ascending limb of the Loop of Henle by furosemide has been also examined. While these approaches produced impressive results in animal models, their clinical benefits remain mixed. This review summarizes the progress in this area and argues that the combination of increasing oxygen supply with decreasing oxygen consumption or different approaches to reducing oxygen demand will be more efficacious.Keywords: mitochondria; oxygenation; hypoxia; Na + -H + exchanger 3; Na + -dependent glucose transporter 2; Na + reabsorption

show abstract

Section: Angiotensin II Inhibitorsmentioning

confidence: 99%

Reducing Oxygen Demand to Alleviate Acute Kidney Injury

Zhou¹

2023

Front. Biosci. (Landmark Ed)

View full text Add to dashboard Cite

show abstract

“…However, increasing evidence supports the well tolerated use of these medications with appropriate monitoring. The concern for medicationinduced acute kidney injury is now known to actually be an increase in serum creatinine due to the expected physiologic response to these medications rather than true kidney injury [26,27,28 ]. Similarly, strong evidence exists in youth and adults that these medications can be used safely in bilateral renal artery stenosis [29].…”

Section: Angiotensin-converting Enzyme Inhibitors and Angiotensin II ...mentioning

confidence: 99%

Management of acute severe hypertension in youth: from the philosophical to the practical

Giammattei

Weaver

South

2022

Current Opinion in Pediatrics

View full text Add to dashboard Cite

Purpose of reviewAcute severe hypertension remains an uncommon but important source of morbidity and mortality in youth. However, there has been very little progress made in our understanding of how to best manage youth with acute severe hypertension to improve patient outcomes.Recent findingsOur understanding of what is acute severe hypertension is undergoing a philosophical change. Management of patients with acute severe hypertension is evolving towards more of a risk and outcomes-based approach.SummaryWe should be intentional when we consider whether a patient has acute severe hypertension and if they are truly at an increased risk for life-threatening target organ injury. We should consider their specific risk factors to best interpret the risks and benefits of how best to treat a patient with acute severe hypertension, rather than relying on traditional approaches and conventional wisdom. We should always ask ‘why’ when we are pursuing a given management course. Future studies should clearly define the research questions they are investigating to best advance the field to ultimately improve patient outcomes.

show abstract

“…In previous reports, ACE2 expression also decreased after the virus infection [ 16 , 17 ]. Urine ACE2 level is increased in patients with COVID-19 and further increased in those that developed AKI, along with a tubular loss of ACE2 in kidney sections [ 18 ]. These are suggesting that decreased ACE2 expression in the kidney induced by virus invasion may be one of the causes of AKI.…”

Section: Introductionmentioning

confidence: 99%

Identification of the regulatory mechanism of ACE2 in COVID-19–induced kidney damage with systems genetics approach

et al. 2023

View full text Add to dashboard Cite

Studies showed that SARS-CoV-2 can directly target the kidney and induce renal damage. As the cell surface receptor for SARS-CoV-2 infection, the angiotensin-converting enzyme 2 (ACE2) plays a pivotal role for renal physiology and function. Thus, it is important to understand ACE2 through which pathway influences the pathogenesis of renal damage induced by COVID-19. In this study, we first performed an eQTL mapping for Ace2 in kidney tissues in 53 BXD mice strains. Results demonstrated that Ace2 is highly expressed and strongly controlled by a genetic locus on chromosome 16 in the kidney, with six genes ( Dnase1 , Vasn , Usp7 , Abat , Mgrn1 , and Rbfox1 ) dominated as the upstream modulator, as they are highly correlated with Ace2 expression. Gene co-expression analysis showed that Ace2 co-variates are significantly involved in the renin-angiotensin system (RAS) pathway which acts as a reno-protector. Importantly, we also found that Ace2 is positively correlated with Pdgf family members, particularly Pdgfc , which showed the most association among the 76 investigated growth factors. Mammalian Phenotype Ontology enrichment indicated that the cognate transcripts for both Ace2 and Pdgfc were mainly involved in regulating renal physiology and morphology. Among which, Cd44 , Egfr , Met , Smad3 , and Stat3 were identified as hub genes through protein–protein interaction analysis. Finally, in aligning with our systems genetics findings, we found ACE2 , pdgf family members, and RAS genes decreased significantly in the CAKI-1 kidney cancer cells treated with S protein and receptor binding domain structural protein. Collectively, our data suggested that ACE2 work with RAS, PDGFC, as well as their cognate hub genes to regulate renal function, which could guide for future clinical prevention and targeted treatment for COVID-19–induced renal damage outcomes. Key messages • Ace2 is highly expressed and strongly controlled by a genetic locus on chromosome 16 in the kidney. • Ace2 co-variates are enriched in the RAS pathway. • Ace2 is strongly correlated with the growth factor Pdgfc. • Ace2 and Pdgfc co-expressed genes involved in the regulation of renal physiology and morphology. • SARS-CoV-2 spike glycoprotein induces down-regulation of Ace2, RAS, and Pdgfc. Supplementary Information ...

show abstract

The effects of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in critically ill patients with acute kidney injury: An observational study using the MIMIC database

Cited by 5 publications

References 44 publications

Reducing Oxygen Demand to Alleviate Acute Kidney Injury

Reducing Oxygen Demand to Alleviate Acute Kidney Injury

Management of acute severe hypertension in youth: from the philosophical to the practical

Identification of the regulatory mechanism of ACE2 in COVID-19–induced kidney damage with systems genetics approach

Contact Info

Product

Resources

About