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Table 1 Main physiological effects of angiotensin II

From: Angiotensin in ECMO patients with refractory shock

Organ system

Physiological effects

Vascular

Vasoconstriction of venous and arterial vessels

Increased vascular permeability

Renal

Stimulation of Na reabsorption and H+ excretion in the proximal tubule via Na+/H+ exchanger

Stimulation of the release of aldosterone

Variable effects on glomerular filtration and renal blood flow depending on the physiological and pharmacological setting:

➢ constriction of the afferent and efferent glomerular arterioles with greater effect on the efferent vessel

➢ constriction of the glomerular mesangium

➢ enhanced sensitivity to tubulo-glomerular feedback

➢ increased local release of prostaglandins which antagonize renal vasoconstriction

Endocrine

Stimulation of the secretion of vasopressin from the posterior pituitary gland

Secretion of ACTH

Enhanced release of noradrenaline from postganglionic sympathetic fibers

Nervous

Enhancement of noradrenaline secretion

Cardiac

Mediation of cardiac remodeling through activated tissue RAS in cardiac myocytes

Coagulation

Prothrombotic potential

Immune

Promotion of cell growth and inflammation

Increased expression of endothelium-derived adhesion molecules

Synthesis of pro-inflammatory cytokines and chemokines

Generation of reactive oxygen species

  1. Abbreviations: ACTH adrenocorticotropin hormone, Ang II angiotensin II, GFR glomerular filtration rate, RAS renin-angiotensin system