Plasma active and inactive renin and fetal complications in women with high risk pregnancies

Renin-Angiotensin-Aldosterone Profiles in Pregnant Women With Chronic Hypertension

Pregnant women with chronic hypertension are at risk for increased blood pressure and superimposed preeclampsia (SPE) in late pregnancy. Alterations in the renin-aldosterone system are a feature of normal pregnancy; however, their role in chronic hypertension with and without SPE is less clear. We performed a prospective, longitudinal trial of 108 women with chronic hypertension and measured plasma renin activity (PRA), 24-hour urine sodium, urine potassium, and urine aldosterone (Ualdo) at 12, 20, 28, and 36 weeks and postpartum. SPE developed in 34% of pregnancies. PRA was lower in women who developed SPE at weeks 28 (5.99 versus 6.22 ng/mL per hour; P<0.001) and 36 (5.71 versus 7.74 ng/mL per hour; P=0.002). Ualdo was lower in women with SPE compared with those without SPE at 28 weeks (59.6 versus 81.3 μg/d; P=0.039). Mean arterial pressure was inversely related to both PRA (r=-0.23; P<0.0001) and Ualdo (r=-0.11; P=0.029). PRA and Ualdo were positively associated with each other (r=0.5327; P<0.0001) after adjusting for urine potassium, urine sodium, serum potassium, and mean arterial pressure. PRA and Ualdo were lower in women of black race compared with other racial groups (P<0.001). Our results demonstrate that in women with chronic hypertension PRA and Ualdo increase in early pregnancy and subsequently decrease in women who develop SPE. These findings are consistent with the hypothesis that sodium retention may contribute to the elevation in blood pressure in SPE.

Inactivation of renin substrate by soybean trypsin inhibitors: implications for measurement of circulating inactive renin

Semipurified soybean trypsin inhibitor added to rat and human plasma leads to a concentration dependent decrease in the rate of angiotensin I generation. This inhibition is due to binding of renin substrate to the inhibitor. Renin substrate present in nephrectomized rat plasma was more susceptible to binding than substrate of the normal rat suggesting structural differences in the substrate generated following nephrectomy. Because trypsin inhibition is necessary for measurement of active and inactive renin, we examined several alternate trypsin inhibitors. The Bowman-Birk inhibitor from soybean had similar actions as purified soybean trypsin inhibitor while trypsin inhibitors from lima bean and chicken did not depress renin substrate, but did have variable effects on the measured levels of active and total plasma renin. Surprisingly, crude soybean trypsin inhibitor did not suppress renin substrate and actually increased angiotensin I generation during PRA and PRC measurements. Since the crude preparation did not suppress renin substrate, changes in the specificity of the inhibitor may occur during its purification. The augmentation of PRA and PRC may be related to angiotensinase inhibitory actions.