Increased efferent pressure (due to efferent vasoconstriction) impedes blood flow out of the glomerulus, so GFR is maintained. When such patients are given an ACE inhibitor or ARB, the protective mechanism is blocked, and renal function can deteriorate rapidly, producing acute renal failure Mechanism of Action ACE is involved in the renin-angiotensin-aldosterone system (RAAS; media item 1) and stimulates the conversion of angiotensin I to angiotensin II. ACE inhibitors are competitive inhibitors of ACE, which prevents the conversion of angiotensin I to angiotensin II The mechanism of action of ACE inhibitors is clear - to prevent conversion of angiotensin I into angiotensin II. Why is this inhibition important? Reducing aldosterone also leads to dilation of the efferent glomerular arterioles, reducing intraglomerular pressure and slowing progression of chronic kidney disease (CKD)
Renal insufficiency occurs commonly in patients with severe bilateral renal artery stenosis who initiate ACE inhibitor use. This problem occurs because ACE inhibitors inhibit efferent renal.. Starting with the first, increased serum creatinine is pretty much inevitable when starting a patient on an ACE-I. Think about the mechanism, and then let's apply that to the kidneys. The decrease in angiotensin II leads to preferential vasodilation of the kidney's efferent arteriole compared to the afferent arteriole
26 years experience Nephrology and Dialysis Block aldosterone: The primary mechanism of action of a ace inhibitors is to interrupt the renin angiotensin system. One of the results is reduced aldosterone synthesis... Angiotensin Converting Enzyme (ACE) Inhibitors ACE inhibitors such as lisinopril and captopril are among the most widely used antihypertensive drugs. The mechanism of action for ACE inhibitors is through decreasing angiotensin II generation Their mechanism of action, however, is very different from ACE inhibitors, which inhibit the formation of angiotensin II. ARBs are receptor antagonists that block type 1 angiotensin II (AT 1) receptors on bloods vessels and other tissues such as the heart
SGLT2i Mechanisms of Action. This works with the effect of ACEi/ARB which inhibit vasoconstriction of the efferent arteriole; SGLT2i (which decreases afferent flow) can still provide improvement in renal outcomes for diabetic kidney disease in patients on maximum doses of ACE inhibitor (which increases efferent flow) Renin-angiotensin-aldosterone system inhibitors are a group of drugs that act by inhibiting the renin-angiotensin-aldosterone system and include angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin-receptor blockers , and direct renin inhibitors ... ACE INHIBITORS AND ARBs The renin-angiotensin-aldosterone system is activated when hypoperfusion to the glomeru-lar afferent arteriole, reduced sodium delivery to the distal convoluted tubule, or increased CURRENT DRUG THERAPY ABSTRACT Angiotensin-converting enzyme (ACE) inhibitors and an-giotensin II receptor blockers (ARBs) are used primarily t
An important component of the beneficial long-term effect of ACE inhibitor therapy in such patients is believed to be due to reversal of glomerular hyperfiltration as a result of predominant efferent arteriolar vasodilatation and a decline in glomerular capillary pressure Although both afferent and efferent arterioles are constricted by angiotensin II, the efferent arteriole has a greater increase in resistance due to a smaller basal diameter (Denton et al. 1992), which may be partly due to different mechanisms of constriction because calcium channel blockers abolish the afferent response while having little or. Angiotensin Converting Enzyme Inhibitors Properties and Side Effects both the afferent and the efferent arterioles so that glomerular capillary pressure is usually maintained un-changed despite either fall of systemic arterial pressure mechanism of action (i.e., the so-called class ef-. Mechanism of action. ACE inhibitors reduce the activity of the renin-angiotensin-aldosterone system (RAAS) as the primary etiologic (causal) event in the development of hypertension in people with diabetes mellitus, as part of the insulin-resistance syndrome or as a manifestation of renal disease. constriction of the efferent arterioles of.
ACE INHIBITORS AND ARBs The renin-angiotensin-aldosterone system is activated when hypoperfusion to the glomeru-lar afferent arteriole, reduced sodium delivery to the distal convoluted tubule, or increased CURRENT DRUG THERAPY ABSTRACT Angiotensin-converting enzyme (ACE) inhibitors and an-giotensin II receptor blockers (ARBs) are used primarily t ii-mediated vasoconstriction of the efferent arteriole. Drugs with antiprostaglandin activ- activity (e.g., angiotensin-converting enzyme [aCE] inhibitors, angiotensin receptor block
greatest vasoconstrictive action on the efferent arteriole versus the afferent arteriole. Additionally, it stimulates secretion of aldosterone from the zona glomerulosa cells of the adrenal glands and induces release of vasopressin from the pituitary; ACE inhibitors therefore decrease blood pressure through a number of mechanisms. ACE. Mechanism of Effects of ACE Inhibitors and ARBs to Slow Progression of CKD. As reviewed in Guidelines 8 and 9, ACE inhibitors and ARBs have a number of class effects that designate them as preferred antihypertensive agents for some types of CKD, even for patients without hypertension. 1. ACE inhibitors and ARBs reduce blood pressure
AT1 receptor antagonists dilate efferent glomerular arterioles, as do ACE inhibitors . Besides renal circulation, treatment with ACE inhibitors with different chemical structures increased splanchnic circulations in an experimental model of RAS activation (water-deprived Brattleboro rats) ( 55 ) or in spontaneously hypertensive rats ( 73 ) The kallikrein-kinin system is involved in the regulation of renal hemodynamics, and thus influences sodium and water excretion, blood pressure, and renin release1, 2, 3.Although bradykinin is known to cause renal vasodilation, its precise site of action in the renal microvasculature is unclear Inhibition of ACE decreases the amount of angiotensin 2 formed from angiotensin 1. This decrease in angiotensin 2 causes a decrease in the glomerular filtration rate by preventing the constriction of efferent arterioles. This dilation of efferent arterioles causes an increase in renin due to loss of negative feedback Stenosis can be due to atherosclerosis or fibromuscular dysplasia In hypotension, effects of Ang-II on the efferent arteriole predominate so that Ang-II increases GFR Potassium supplements/ Potassium sparing diuretics will cause hyperkalemia Bradykinin is a potent vasodilator by its action on B2 receptor Dilation of the efferent arteriole will facilitate blood movement out of the glomerulus, lowering the intraglomerular pressure independent of any change in systemic blood pressure. A brief review of the actions of angiotensin II on glomerular hemodynamics is available elsewhere. (See Renal effects of ACE inhibitors in hypertension.
Efferent arterioles were preconstricted with norepinephrine, and increasing doses of bradykinin were added to the perfusate in the presence or absence of COX and cp450 inhibitors. When efferent. It is known that ACE-2 acts as functional receptor for coronaviruses including SARS-CoV-2. Since ACE inhibitors inhibit ACE-1 activity and increase ACE-2 activity substantially over one to two weeks, many people were worried that ACE inhibitors may increase susceptibility to the virus and severity of disease Angiotensin II also causes vasoconstriction of the afferent and efferent arterioles of the kidney, exerting a more significant effect on the efferent arterioles. Enalaprilat administration in the presence of hypovolemia can cause renal injury due to inadequate renal perfusion. ACE breaks down bradykinin, a peptide that causes vasodilation ACE inhibitors and renal artery stenosis. Dr Raj Thakkar outlines the risks and benefits of ACE inhibitor therapy in renal disease
Mechanism of action. Angiotensin converting enzyme inhibitors are a class of oral medications that act primarily through blockade of the angiotensin converting enzyme Mechanism involved in bradykinin-induced efferent arteriole dilation. as well as its mechanism of action. We found that in the isolated microperfused Ef-Art, laser Doppler studies demonstrated that following treatment with an angiotensin-converting enzyme (ACE) inhibitor, a bradykinin antagonist markedly blunted increased papillary.
The increase of bradykinin in the myocardium also has a cardioprotective effect. Growth appears to be inhibited in both the heart and the vessels, which leads to reduced mortality during ACE inhibitor treatment.A renal protective effect is significant during ACE inhibitor treatment as well. The efferent arterioles of the kidneys are vasodilated and the glomerular filtration rate is decreased. ACE inhibitors and angiotensin-converting enzyme receptor blockers interfere with the renin-angiotensin-aldosterone regulatory system, producing vasodilation and natriuresis, as well as having long-term benefits which are mainly related to their anti-inflammatory and antiproliferative effects. Pharmacologically this is achieved by inhibiting the conversion of angiotensin I into angiotensin II. The renin-angiotensin-aldosterone system (RAAS) plays an important role in regulating blood volume and systemic vascular resistance, which together influence cardiac output and arterial pressure.As the name implies, there are three important components to this system: 1) renin, 2) angiotensin, and 3) aldosterone . All this results in decreasing blood pressure
. An additional effect of these drugs is the preserving of bradykinin which acts as a vasodilator, as it is degraded by the angiotensin-converting enzyme Hemodynamically, angiotensin II (Ang II) has a relatively greater vasoconstrictive effect on efferent than on afferent arterioles. In addition, Ang II decreases the glomerular ultrafiltration coefficient. These combined effects result in increased intraglomerular capillary pressures It is worth mentioning that the mechanism of SGLT2 inhibitors is different from the ones seen in RAAS blockers, given that these agents also decrease intraglomerular pressure by causing vasodilation of the efferent arteriole [26,27]. RAAS inhibitors act by either inhibiting the angiotensin-converting enzyme (ACE) or by blocking the angiotensin. strictor action ofangiotensin II is primarily on the efferent arteriole, ACE may reduce glomerular hypertension by preferential vaso-dilatation of the efferent arteriole, thereby reducing glomerular pressure. Secondly, angiotensin II may act as a growth factor within the glomerulus, and successful use of ACE inhibition may thereby reduce glomer.
This effect on the kidney is reflected in an expected slight rise in creatinine after initiating ACE inhibitor therapy.The expected rise is usually between 10 and 20%. Acute kidney insufficiency (AKI) is defined as a rise greater than 0.5 if the serum creatinine was initially less than 2.0 mg/dL or more than 1.0 if the baseline was greater than 2 These uncertain renoprotective effects may be due to the presence of L‐type calcium channels at the afferent but not efferent arterioles of the kidney. 89 L‐type CCB cause afferent vasodilation which would theoretically increase GFR and intraglomerular pressure in case of unaffected efferent resistance. This adverse action counteracts their. Make sure to include the effects of the drug on urine volume and concentration. Make sure to identify the cellular mechanisms of action of the drug. C ACE inhibitors are a class of drugs that inhibit angiotensin-converting enzyme (ACE) in the renin- angiotensin-aldosterone system Use of ACE inhibitors or ARBs : ACE inhibitors and ARBs prevent efferent arteriole vasoconstriction which is also important in maintenance of GFR: Use of the 'triple whammy' (ACE inhibitor or ARB plus diuretic plus NSAID) Diuretic may cause volume depletion. See above for ACE inhibitor/ARB effects
Captopril was the first ACE inhibitor to be marketed. It has a relatively short half life of 2 hours resulting in short duration of action meaning that Captopril must be given 2/3 times daily and therefore has been mostly replaced by later ACE inhibitors, such as Enalapril. Enalapril is a pro-drug of which the active metabolite is enalaprilat Mechanism of Action of ACE-I/ARB and Possible Mechanisms for Benefit or Harm in CIN ACE-Is act by inhibiting the renin-angiotensin-aldosterone system (RAAS), specifically the conversion of angiotensin-I to angiotensin-II, thereby causing vasodilatation of the efferent renal arterioles and thus decreasing the intraglomerular pressures [ 17 ]
The ACE inhibitors are drugs that inhibit the formation of angiotensin II and are used for blood pressure control and congestive heart failure.The final mechanism of action is the relaxation of small peripheral vessels known as arterioles Pregnancy: ACE inhibitors can cause fetal hypotension, renal failure & fetal malforations or death when taken during the 2nd & 3rd trimesters. In addition, first trimester use of ACE inhibitors, has also been associated with a potential risk of birth defects in retrospective data (rxlist.com Enalapril Warnings).Once pregnancy is diagnosed, it is essential that ACE inhibitors be discontinued as. ACE inhibitors and angiotensin-receptor blockers can cause a temporary increase in creatinine. Why? Because they temporarily decrease GFR; think, if angiotensin increases GFR by constricting the efferent arteriole, then ACE inhibitors decrease GFR by dilating the efferent arteriole This is well known with ACE inhibitors and is brought about by a class effect of these drugs rather than by a toxic effect or overdose. If the efferent arteriole is controlled by Ang II rather than bradykinin, it would be expected that ACE inhibitors and AT 1 receptor antagonists alter GFR in a comparable manner. However, experimental data have. The function of an angiotensin-converting enzyme (ACE) inhibitor is to reduce the activity of the renin-angiotensin-aldosterone system [5, 6]. One of the mechanism is to maintain the blood pressure by releasing renin (a type of protein) from cells in the kidney [5, 6]
Summary ACE inhibitors (ACEIs) are a class of drugs that work by inhibiting angiotensin-converting enzyme (ACE). ACE inhibitors as a drug class have names ending in the suffix -pril, including lisinopril, enalapril, ramipril, captopril, and benazepril. The clinical effects of ACE inhibitors can be primarily broken into two main effects: first, they prevent conversion of angiotensin I into. FIGURE 18.2 The intrarenal RAAS, depicting the effect on the renal circulation of lowering BP with an ACE inhibitor. Renin secretion will be increased due to the decrease in pressure and flow in the afferent arteriole (A), but since conversion of angiotensin I to angiotensin II (Ang II) is inhibited, there will be less Ang II-mediated constriction of the efferent arteriole (E) and a fall in. Inhibitors of angiotensin-converting enzyme are often used to reduce the formation of the more potent angiotensin II. Captopril is an example of an ACE inhibitor . ACE cleaves a number of other peptides, and in this capacity is an important regulator of the kinin-kallikrein system, as such blocking ACE can lead to side effects SGLT2 Inhibitors and nephroprotection in diabetic kidney disease: From mechanisms of action to the latest evidence in the literature More Information August 2020 DOI: 10.29328/journal.jcn.100105 A second action of Angiotensin II is to cause chronic damage to the kidneys in diabetes. production also reduces pressure directly in the kidneys, by preventing angiotensin from constricting the outgoing, or efferent, arteriole (small artery). Although angiotensin-converting enzyme inhibitors are frequently used as antihypertensive.
Mechanism of Action Inhibits ACE Decreases GFR Inhibits Constriction of Efferent Arteriole Side Effect Increased Bradykinin Cough. PLAY. 1 min. ACE Inhibitor Toxicity. CAPTOPRIL Mnemonic Cough Angioedema Potassium Changes (Hyperkalemia) Taste Change Hypotension Pregnancy Changes Ras Learn Antihypertensive Agents - Pharmacology - Cardiology - USMLE Step 2 - Picmonic for Medicine faster and easier with Picmonic's unforgettable videos, stories, and quizzes! Picmonic is research proven to increase your memory retention and test scores. Start learning today for free It is well known that ACEi stimulates bradykinin activity , and we previously demonstrated that an ACEi caused increased vasodilator action on efferent arterioles than an ARB in dog kidneys, the. This article reviews the mechanisms underlying altered vascular resistance of afferent or efferent arterioles in diabetic nephropathy. Calcium and potassium channels Afferent arteriolar dilation observed in early stage diabetes is associated with its diminished responses to a variety of vasoconstrictor stimuli Though antihypertensive drugs have been in use for many decades, the mechanisms by which they act chronically to reduce blood pressure remain unclear. Over long periods, mean arterial blood pressure must match the perfusion pressure necessary for the kidney to achieve its role in eliminating the daily intake of salt and water. It follows that the kidney is the most likely target for the action.
MB BULLETS Step 1 For 1st and 2nd Year Med Students. MB BULLETS Step 2 & 3 For 3rd and 4th Year Med Students. ORTHO BULLETS Orthopaedic Surgeons & Provider Lisinopril is an ACE inhibitor. ACE normally converts angiotensin I to angiotensin II, which is a potent vasoconstrictor. Reducing angiotension II leads to reduced aldosterone secretion, which decreases sodium and water resorption. ACE inhibitors also inhibit the degradation of the peptide bradykinin that stimulates the release of the.
mediated through renal vascular mechanisms, while ACE inhibitors (like AT(1) antagonists) have a more persistent effect on blood pressure after treatment withdrawal compared with other antihypertensive drugs. Taken together, the evidence suggests that structural narrowing of the renal afferent arteriole coul Competitive inhibition of Angiotensin Converting Enzyme has an important role in cardiovascular diseases, which has been demonstrated by various extensive studies. Based on pharmacologic and mechanism of action, the pharmacodynamic of ACE-inhibitor involves some specific system, such as hemodynamic, neurohormonal, anti Mechanism of Action ACE (angiotensin converting enzyme) cleaves inactive angiotensin I to active angiotensin II which is a potent vasoconstrictor. ACE is also involved in breakdown of bradykinin, a peptide that increases production of nitric oxide and prostacyclin, both of which are potent vasodilators Mechanism of action. and transglomerular hydrostatic pressure is then maintained by angiotensin II-induced constriction of the efferent arteriole. When an ACE inhibitor is given, the efferent arteriole relaxes, glomerular filtration pressure falls, and renal failure may result. ACE inhibitors can lead to the thrombotic occlusion of a. Mechanism of Action: Na/K/2Cl co-transporter -- sensitive to luminal chloride concentration changes. renal vascular receptor- - afferent arteriole
Mechanism of action: -Combination of ACE-inhibitor effects (Inhibits production of Angiotensin II-Effects inhibited) -Combination of NEP-inhibitor (Inhibits activity of NEP against signalling molecules) *Dramatic effect on Blood pressure and improves HF symptoms The vasodilator action on efferent arterioles appears to be mediated in part by the blockade of T-type calcium channels, particularly through the inhibition of the intracellular calcium release. ACE inhibitors and ARBs. The degree of proteinuria depends on the integrity (charge and size selectivity) of the glomerular capillary wall (GCW) and the intraglomerular pressure. Intraglomerular pressure is controlled by the afferent arteriole, which transmits systemic blood pressure to the glomerulus, and the efferent arteriole Summary - Afferent vs Efferent Arterioles The nephron is the functional unit of the kidney, and the major function (ultrafiltration) of the kidney is mainly carrying out by nephrons. The nephron is composed of renal corpuscle having capillaries known as glomerulus and encompassing structure called as Bowman's capsule.The renal artery provides blood to the glomerulus which is to be filtered Angiotensin II is a strong vasoactive peptide that causes blood vessels to constrict leading to increased blood pressure, and it mainly works on the efferent arterioles of the kidney. Angiotensin II also stimulates the secretion of the hormone aldosterone from the zona glomerulosa in the adrenal cortex
Arteriole Myogenic Mechanism. Recall that the DCT is in intimate contact with the afferent and efferent arterioles of the glomerulus. ACE is important in increasing blood pressure and this is why people with high blood pressure are sometimes prescribed ACE inhibitors to lower their blood pressure The mechanism appears to be the blockade of bradykinin breakdown, for which ACE is also responsible. Incidentally, ACE is also responsible for the breakdown of enkephalins, neurotensin, substance P and luteinising hormone-releasing hormone (though fortunately none of these lead to weird side effects) People with high blood pressure are sometimes prescribed ACE inhibitors to lower their blood pressure. Angiotensin II is a potent vasoconstrictor that plays an immediate role in the regulation of blood pressure. It acts systemically to cause vasoconstriction as well as constriction of both the afferent and efferent arterioles of the glomerulus Similarly at efferent arterioles AT II maintains high blood pressure by vasoconstriction. If this physiological mechanism is disturbed by any drugs may lead to fall in GFR and subsequent renal failure on long term. Two such drugs which effect renal function include NSAIDS acting on afferent arterioles and ACEI, ARBs acting on efferent arterioles Both the afferent and efferent arterioles are regulated through hormones (and drugs that inhibit the hormones). Prostaglandins dilate the afferent arterioles, and NSAIDs inhibit this action. Angiotensin II preferentially constricts the efferent arteriole, and this action is restricted by an ACE inhibitor. (Source: First Aid for the USMLE Step 1
ACE inhibitors, as their name indicates, inhibit conversion of angiotensin I to angiotensin II by ACE, resulting in vasodilation of the efferent arteriole and a drop in blood pressure. Inhibition of ACE, a kininase, also results in a rise in kinins Proteinuria and ACE: Ace-inhibtors reduced proteinuria (p) by reducing the vasoconstriction caused by angiotensin ii on the efferent arteriole (ea) of the glomerulus. Once this pressure is reduced, there is less back pressure in the glomerulus, thereby reducing the amount of p the patient has
Normal NSAID/ACE‐I Interaction Afferent arteriole Afferent arteriole Efferent arteriole Efferent Effects on the Kidney Glomerulus Glomerulus Tubule Tubule Blood flow Blood flow • Purpose of each ingredient • Acetaminophen • Aspirin • Caffeine • Mechanism of action • Caffeine -vasoconstriction = increase blood pressur Angiotensin-converting-enzyme inhibitors Kidney problems may occur with all ACE inhibitors that directly follows from their mechanism of action. Further, constriction of the efferent arterioles of the kidney leads to increased perfusion pressure in the glomeruli The renal mechanisms underlying the renal adverse effects of ACE inhibitors — intrarenal efferent vasodilation with a consequent fall in filtration pressure — are held to be involved in their renoprotective effects as well Mechanism of action ACE inhibitors reduce the activity of the renin-angiotensin-aldosterone system (RAAS) as the primary etiologic (causal) event in the development of hypertension in people with diabetes mellitus, as part of the insulin-resistance syndrome or as a manifestation of renal disease
ACE inhibitors inhibit production of angiotensin II thus suppressing the action of angiotensin II on both AT1 and AT2. In contrast, the effect of AT1-receptor antagonists is to selectively block the activation of the AT1 receptor. are present in both afferent and efferent arteriole of the glomerulus, and that angiotensin II induces afferent. Efferent Arteriole Glomerular Filtration • 3 layers 1) Fenestrated capillary endothelium ACE inhibitors • Angiotensin II causes efferent arteriolar vasoconstriction • Maintains pressure in glomerular capillary and GFR • Mechanism of action: - + Reduces reabsorptive gradient for N Hence drugs with different mechanisms of action are combined. Eg: Drugs which increase plasma renin activity— diuretics, vasodilators, CCBs, ACE inhibitors may be combined with drugs which lower plasma renin activity—β blockers, clonidine, methyldopa. 56 ACE is a target of ACE inhibitor drugs, which decrease the rate of angiotensin II production. Angiotensin II increases blood pressure by stimulating the Gq protein in vascular smooth muscle cells (which in turn activates an IP3-dependent mechanism leading to a rise in intracellular calcium levels and ultimately causing contraction)
ACE- Inhibitors (or angiotensin converting enzyme inhibitors to give them their Sunday name) are a commonly utilised medication in the management of hypertension. Above is the renin angiotensin aldosterone system ACE inhibitors work between the stage of Angiotensin 1 which is inactive being converted to the active form of angiotensin 2 ACE inhibitors suppress this RAS pathway by inhibiting angiotensin converting enzyme (ACE) which is widely distributed in the circulation and tissues (Veltmar, 1991). This inhibition decreases the formation of a potent vasoconstrictor, angiotensin II, and slows the degradation of the potent vasodilator, bradykinin (Appendix) Thus, although both ACE-I and ARB dilate efferent arterioles, ACE-I is more potent in dilating the efferent arteriole of superficial nephrons when administered acutely in experimental animals. 7,8.
The change in renal function with ARBs given to patients with or without renal disease appears to differ little from that seen with ACE inhibitors. In the untreated state efferent arteriolar tone is presumably increased and glomerular hyperfiltration exists (left panel). The change in the diameter of the efferent arteriole is greater with ACE. Efferent arteriole: Vasoconstriction: Angiotensin: Proximal convoluted tubule: Na reabsorption ACE inhibitors (ACEI)-Prils: HTN & HF: Angiotensin antagonists (ARB)-Sartans: HTN & HF: Aldosterone antagonists: Spironolactone: Diuretics Eplerenone: Diuretics: Mechanisms of Action of Diuretics. Mechanism Mnemonic Medication Indications Location.
Glomerular Filtration and Tubular Function. Describe glomerular filtration and tubular function. Glomerulus. The glomerulus is a set of capillaries which invaginate Bowman's capsule; Fluid filters out of the capillary bed into Bowman's space based on Starling forces:. Membrane permeabilit and the use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are foundational Mechanism of action of SGLT-2 inhibitors - proposed renal protective pathways blockers act on efferent arteriole vasodilatation to reduce intraglomerular hypertension. The combination o In experimental studies a low-protein diet (LPD) and renin-angiotensin-aldosterone system (RAAS) inhibitors are both reported to slow the progression of chronic kidney disease (CKD) and reduce proteinuria. RAAS activity contributes to increased blood pressure, fluid retention, and positive sodium balance, but also to kidney damage by enhancing glomerular capillary filtration pressure and.