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Current Hypertension Reports

Open Access 02-08-2024 | Pre-Eclampsia | Preeclampsia (A Kattah and VD Garovic, Section Editors)

Importance of the (Pro)renin Receptor in Activating the Renin-Angiotensin System During Normotensive and Preeclamptic Pregnancies

Authors: Lachlan G. Schofield, Saije K. Endacott, Sarah J. Delforce, Eugenie R. Lumbers, Kirsty G. Pringle

Published in: Current Hypertension Reports

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Abstract

Purpose of Review

For a healthy pregnancy to occur, a controlled interplay between the maternal circulating renin–angiotensin–aldosterone system (RAAS), placental renin-angiotensin system (RAS) and intrarenal renin-angiotensin system (iRAS) is necessary. Functionally, both the RAAS and iRAS interact to maintain blood pressure and cardiac output, as well as fluid and electrolyte balance. The placental RAS is important for placental development while also influencing the maternal circulating RAAS and iRAS. This narrative review concentrates on the (pro)renin receptor ((P)RR) and its soluble form (s(P)RR) in the context of the hypertensive pregnancy pathology, preeclampsia.

Recent Findings

The (P)RR and the s(P)RR have become of particular interest as not only can they activate prorenin and renin, thus influencing levels of angiotensin II (Ang II), but s(P)RR has now been shown to directly interact with and stimulate the Angiotensin II type 1 receptor (AT1R). Levels of both placental (P)RR and maternal circulating s(P)RR are elevated in patients with preeclampsia. Furthermore, s(P)RR has been shown to increase blood pressure in non-pregnant and pregnant rats and mice.

Summary

In preeclamptic pregnancies, which are characterised by maternal hypertension and impaired placental development and function, we propose that there is enhanced secretion of s(P)RR from the placenta into the maternal circulation. Due to its ability to both activate prorenin and act as an AT1R agonist, excess maternal circulating s(P)RR can act on both the maternal vasculature, and the kidney, leading to RAS over-activation. This results in dysregulation of the maternal circulating RAAS and overactivation of the iRAS, contributing to maternal hypertension, renal damage, and secondary changes to neurohumoral regulation of fluid and electrolyte balance, ultimately contributing to the pathophysiology of preeclampsia.
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Metadata
Title
Importance of the (Pro)renin Receptor in Activating the Renin-Angiotensin System During Normotensive and Preeclamptic Pregnancies
Authors
Lachlan G. Schofield
Saije K. Endacott
Sarah J. Delforce
Eugenie R. Lumbers
Kirsty G. Pringle
Publication date
02-08-2024
Publisher
Springer US
Keyword
Pre-Eclampsia
Published in
Current Hypertension Reports
Print ISSN: 1522-6417
Electronic ISSN: 1534-3111
DOI
https://doi.org/10.1007/s11906-024-01316-1

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