Role of the renin angiotensin system in diabetic nephropathy

Diabetic nephropathy has been the cause of lot of mor bidity 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 var ious subsystems which contribute to the disease pat ho logy.One of these involves angiotensin Ⅱ(Ang Ⅱ) which shows in c reased activity during diabetic nephropathy.This causes hypertrophy of various renal cells and has a pres sor effect on arteriolar smooth muscle resulting in increas ed vascular pressure.Ang Ⅱ also induces inflamm ation,apoptosis,cell growth,migration and differentiation.Monocyte chemoattractant protein-1 production responsible for renal f ibrosis is also regulated by RAS.Polymorphism of angiotensin converting enzym e(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 ang iot ensin 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.