Interaction of prostaglandins and angiotensin II in the modulation of renal function in congestive heart failure

M. Packer

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

Despite a dramatic fall in renal blood flow, glomerular filtration rate is usually preserved in patients with congestive heart failure until the terminal stages of the disease. This maintenance of renal function appears to be achieved in part by the synthesis of two vasoactive factors within the kidney - angiotensin II and prostaglandins - which are rapidly released whenever renal perfusion is compromised or sympathetic nerve traffic to the kidneys is increased. Although these two hormonal systems exert opposite effects on systemic and renal blood flow and sodium and water excretion, both act to preserve glomerular filtration rate: prostaglandins by a vasodilator action exerted primarily on the afferent arteriole and angiotensin II by a vasoconstrictor effect on the efferent arteriole. Consequently, when the synthesis of these hormones is experimentally blocked, renal function deteriorates, especially in subjects with marked renal hypoperfusion and sodium depletion; these two factors interact to determine the importance of intrarenal hormonal release in the modulation of renal function. Clinically, four specific factors have been identified that predispose patients with heart failure to the development of functional regnal insufficiency after treatment with converting-enzyme or cyclo-oxygenase inhibitors: (1) marked renal hypoperfusion, (2) vigorous diuretic therapy, (3) diabetes mellitus, and (4) intensity of hormonal inhibition within the kidney. This last risk factor may provide the basis for differentiating among enzyme-inhibitory drugs and suggests that renal insufficiency in low-output states may be minimized by the development of therapeutic agents that block hormonal synthesis selectively at sites that are critical to the disease process but spare the homeostatic tissue-based enzyme systems that exist within the kidney.

Original languageEnglish (US)
JournalCirculation
Volume77
Issue number6 II SUPPL.
StatePublished - 1988

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Angiotensin II
Prostaglandins
Heart Failure
Kidney
Renal Circulation
Arterioles
Glomerular Filtration Rate
Enzymes
Sodium
Cyclooxygenase Inhibitors
Vasoconstrictor Agents
Vasodilator Agents
Diuretics
Renal Insufficiency
Diabetes Mellitus
Therapeutics
Perfusion
Maintenance
Hormones
Water

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Interaction of prostaglandins and angiotensin II in the modulation of renal function in congestive heart failure. / Packer, M.

In: Circulation, Vol. 77, No. 6 II SUPPL., 1988.

Research output: Contribution to journalArticle

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