Body Mass Index and Angiotensin-Dependent Control of the Renal Circulation in Healthy Humans
Abstract
Obesity is increasingly recognized as a risk factor for renal disease, but the mechanism is unclear. Renal plasma flow response to captopril, as an index of renin-angiotensin system activity, was measured by para-aminohippurate clearance technique in 100 healthy, normotensive subjects in balance on a high-salt diet. Of the 100 subjects, body mass index exceeded 25 in 56 and exceeded 30 in 22. The average vasodilator response to captopril was 27±7 mL/min per 1.73 m 2 ( P <0.0001). After adjustment for other predictors of the renal plasma flow response to captopril using a multivariate linear regression model, there was a highly significant relationship between age- and plasma renin activity–adjusted body mass index and the renal plasma flow response to captopril; however, a quadratic model provided a substantially better fit ( r =0.55; P <0.0001; P =0.03 versus linear correlation). The strong association between increasing body mass index and angiotensin-dependent control of the renal circulation suggests that this may be a mechanism by which obesity contributes to renal disease. Weight loss should be considered in the overweight or obese patient for renal protection.
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Obesity predisposes the kidney to reabsorb sodium by neural, hormonal, and renovascular mechanisms.
“Obesity predisposes the kidney to reabsorb sodium by neural (SNS), hormonal (aldosterone and insulin), and renovascular (angiotensin II) mechanisms.37”
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“In addition, food intake and obesity are associated with activation of the renin-angiotensin system (Corman et al., 1988; Cassis et al., 1998; Ahmed et al., 2005).”
BackgroundDiabetes, nephropathy, and the renin system
Hollenberg, N. K. (2006) · Journal of Hypertension · doi:10.1097/01.hjh.0000220411.76740.bf · Cited by 18 · see citing works
Self-citationNationwide, Pragmatic, Direct-to-Patient Primary Aldosteronism Testing Program
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“18,19,40,42 If PA testing was considered positive based on a low PRA ≤ 1 ng/mL per hour regardless of aldosterone concentration in those patients on ACE/ARB at the time of screening (n=506), this resulted in reclassification of 52 participants, for a positive rate of 32.9%.”
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“Insulin resistance may cause dyslipidemia, salt retention, autonomic dysfunction, and renal hemodynamic change (23).”
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“In this study, we measured urinary biomarkers such as AGT as an index of intrarenal RAS status, MDA as a marker of oxidative stress, MCP-1 as an index of inflammation status, adiponectin, and podocalyxin as a marker of podocyte injury.”
BackgroundInfluentialMechanisms and treatment of obesity-related hypertension—Part 2: Treatments
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“Obese subjects are also exposed to excess-risk of kidney hypoperfusion because of exaggerated hemodynamic responses to sympathetic-nervous system ( SNS) and/or renin–angiotensin system ( RAAS) inhibitors [20 , 21 ].”
Oral contraceptive progestins and angiotensin-dependent control of the renal circulation in humans
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Looking for new diagnostic tools and biomarkers of hypertension in obese pediatric patients
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Racial differences in renal vascular response to angiotensin blockade with captopril or candesartan
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Self-citationSex influences the effect of body mass index on the vascular response to angiotensin II in humans
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“Cardiorenal risk is associated with renin–angiotensin–aldosterone system (RAAS) upregulation (10) and previous studies have shown that RAAS activity levels increase with increased BMI (11) and differs in men compared to women (12).”
BackgroundSelf-citationAntihypertensive therapy in the obese hypertensive patient
Chrostowska, M., Szczęch, R., & Narkiewicz, K. (2006) · Current Opinion in Nephrology & Hypertension · doi:10.1097/01.mnh.0000242173.14082.dc · Cited by 8 · see citing works
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“Due to this the person progressively develops hypertension([43,44]).”
BackgroundRenin‐Angiotensin System Polymorphisms and Risk of Hypertension: Influence of Environmental Factors
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Self-citationThe “Weight” of Obesity on Arterial Hypertension
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“Specifically, obesity and diabetes may cause hypertension by increased activation of the renin-angiotensin-aldosterone system [21,22].”
Eguchi, K., Izumi, Y., Nakayama, Y., Inoue, H., Marume, T., Matsuo, N., Hiramatsu, A., Ono, M., Kakizoe, Y., Kuwabara, T., et al. (2018) · Nephrology · doi:10.1111/nep.13553 · Cited by 3 · see citing works
“Obese patients exhibit upregulation in RAAS and are susceptible to RAAS blockers.(20,21) Since RAAS blockers are currently necessary for the treatment of CKD, induction of alkalization therapy should be considered, especially in overweight/obese patients, from the early stage of CKD.”
BackgroundMechanisms for Obesity Related Kidney Disease
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Alterations of White Matter Connectivity in Adults with Essential Hypertension
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“35 Penetrating cerebral arteries plays a crucial role by supplying oxygen and nutrients to the white matter regions, maintaining normal brain tissue function.”
BackgroundStudy of various dietary interventions in patients with hypertension and metabolic syndrome
Khachatryan, M. T., Zhernakova, Y. V., Blinova, N. V., & Chazova, I. E. (2024) · Systemic Hypertension · doi:10.38109/2075-082x-2024-1-29-35 · Cited by 3 · see citing works
Renal hemodynamics in overweight and obesity: pathogenetic factors and targets for intervention
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Implications and Management of Obesity in Kidney Disease
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Angiotensinogen and interleukin 18 in serum and urine of children with kidney cysts
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Pathogenesis of Hypertension and Renal Disease in Obesity
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Enfermedad renal asociada al sindrome metabólico
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“[10] It is not yet clear how insulin resistance modulates the RAS.”
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Implications and Management of Obesity in Kidney Disease
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- Authors
- Ahmed, S. B., Fisher, N. D. L., Stevanovic, R., & Hollenberg, N. K.
- Affiliations
- Brigham and Women's Hospital (US)
- Venue
- Hypertension
- Published
- 2005-12
- Volume
- 46
- Issue
- 6
- Pages
- 1316-1320
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2170919561
- Cited by
- 92
- References
- 44
- Citations by year
- 2025: 2 · 2024: 2 · 2023: 4 · 2022: 2 · 2021: 2 · 2020: 3 · 2019: 8 · 2018: 2 · 2017: 8 · 2016: 2 · 2015: 4 · 2014: 2 · 2013: 7 · 2012: 7
- FWCI
- 4.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Kidney Foundation of Canada
- National Institutes of Health
- U.S. Public Health Service (P01-AC00059916, 1P50ML 5300001)
- National Heart, Lung, and Blood Institute (T32HL07609, T32HL007609)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal and Vascular Pathologies
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Keywords
- body mass index, obesity, renin-angiotensin system, renal plasma flow, captopril, renal circulation, plasma renin activity, renal disease risk, weight loss, high-salt diet
- MeSH terms
- Adult, Aging, Angiotensin-Converting Enzyme Inhibitors, Angiotensins, Captopril, Dose-Response Relationship, Drug, Female, Hemodynamics, Humans, Male, Middle Aged, Reference Values, Renal Circulation, Renin, Vasodilation, Body Mass Index, Multivariate Analysis, Linear Models, Sodium Chloride, Dietary
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