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An Antigen-Independent Important Hormone: Intrarenal Angiotensin II (AII) as a Key to Understanding Chronic Allograft Nephropathy

Lynn M. Jacobson

Debra A. Hullett

Chronic allograft nephropathy (CAN) is a multifactorial lesion. There has been a graduallyincreasing recognition of the importance of antigen-independent factors influencingthe development and progression of CAN. One important antigen-independent hormonein this setting is angiotensin II (AII), which is associated with progressive kidneydisease. Although the pathogenesis of native kidney disease may differ from CAN, thechronic progressive nature of both entities raises the hypothesis that AII also has a rolein CAN. However, AII also serves as a theoretical focal point, linking many of the factorsinvolved in CAN. Fortunately, we have therapies, angiotensin converting enzyme inhibitors(ACE-I), and type 1 angiotensin II receptor (AT₁ R) antagonists that can alter theeffects of AII in grafts. We can treat renal transplant recipients with such therapies in thehopes of preserving graft function. At the same time, given AII's apparent central role inCAN, we can potentially glean novel information as to the pathogenesis and optimaltreatment of CAN.

Key Words: angiotensin II • chronic allograft nephropathy • kidney transplantation

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