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World J Diabetes. Nov 15, 2010; 1(5): 141-145
Published online Nov 15, 2010. doi: 10.4239/wjd.v1.i5.141
Role of the renin angiotensin system in diabetic nephropathy
Tanuj Chawla, Deepika Sharma, Archana Singh
Tanuj Chawla, Department of Pharmacology, Lady Hardinge Medical College and Associated Hospitals, New Delhi 110001, India
Deepika Sharma, Department of Biochemistry, Lady Hardinge Medical College and Associated Hospitals, New Delhi 110001, India
Archana Singh, Department of Biochemistry, University College of Medical Sciences, Delhi 110095, India
Author contributions: Chawla T wrote, corrected and finally approved the manuscript; and Sharma D and Singh A collected data and wrote the manuscript.
Correspondence to: Archana Singh, MD, Lecturer, Department of Biochemistry, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi 110095, India. archanasinghmamc@gmail.com
Telephone: +91-986-8450254
Received: May 26, 2010
Revised: September 1, 2010
Accepted: September 8, 2010
Published online: November 15, 2010
Abstract

Diabetic nephropathy has been the cause of lot of morbidity and mortality in the diabetic population. The renin angiotensin system (RAS) is considered to be involved in most of the pathological processes that result in diabetic nephropathy. This system has various subsystems which contribute to the disease pathology. One of these involves angiotensin II (Ang II) which shows increased activity during diabetic nephropathy. This causes hypertrophy of various renal cells and has a pressor effect on arteriolar smooth muscle resulting in increased vascular pressure. Ang II also induces inflammation, apoptosis, cell growth, migration and differentiation. Monocyte chemoattractant protein-1 production responsible for renal fibrosis is also regulated by RAS. Polymorphism of angiotensin converting enzyme (ACE) and Angiotensinogen has been shown to have effects on RAS. Available treatment modalities have proven effective in controlling the progression of nephropathy. Various drugs (based on antagonism of RAS) are currently in the market and others are still under trial. Amongst the approved drugs, ACE inhibitors and angiotensin receptor blockers (ARBs) are widely used in clinical practice. ARBs are shown to be superior to ACE inhibitors in terms of reducing proteinuria but the combined role of ARBs with ACE inhibitors in diabetic nephropathy is under debate.

Keywords: Diabetic nephropathy; Angiotensin II; Monocyte chemoattractant protein-1; Renin angiotensin system