Role of the renin-angiotensin system in disorders of the urinary tract

Purpose: The role of the renin-angiotensin system in the homeostasis of fluid, electrolyte and blood pressure has been known for quite some time. Recent developments indicate that angiotensin has a profound role, not only in the developing urinary tract but also in the response of the urinary tract to injury. In this review we outline these characteristics. Materials and Methods: We summarize the clinical approach to congenital abnormalities of the kidney and urinary tract, and report new data obtained in genetically engineered mice. Furthermore, we present the connection between the mutant mice observations and human congenital abnormalities. Results: Genetically engineered mutants clearly indicate that the renin-angiotensin system is important for normal renal and urological development. As in glomerular disease, the renin-angiotensin system is involved in progressive damage due to urological disease. Conclusions: While the renin-angiotensin system is important for blood pressure regulation, it also affects the embryogenesis of the urinary tract and modulates renal injury due to specific disease processes. The importance of angiotensin and its blockade provides an exciting avenue for possible early treatment in children with congenital anomalies of the kidney and urinary tract.