FUNCTIONS OF THE RENIN-ANGIOTENSIN SYSTEM DURING DEVELOPMENT

1. From studies in chronically catheterized fetal sheep and other species, it can be shown that the renin-angiotensin system (RAS) is active during intra-uterine life. Levels of angiotensin II (AII) in fetal sheep are similar to maternal. 2. The fetal RAS plays a role in maintenance of arterial pressure. The extent to which it does so depends on the level of activity of the system. 3. The distribution of renin within the fetal rat kidney is much more widespread than in the adult. The fetal kidney, like other vascular beds has high levels of the AT₂ angiotensin receptor subtype. With maturation the proportion of the AT₁ receptor subtype increases. 4. Blockade of the fetal RAS with angiotensin converting enzyme (ACE) inhibitors or with the non-peptide AII antagonist (losartan) caused a fall in fetal glomerular filtration rate (GFR) and a rise in renal blood flow (RBF). AII reverses the fall in GFR even though RBF decreases. 5. The fraction of the filtered sodium load reabsorbed by the proximal tubule was not affected when the fetal RAS was blocked by captopril or losartan. High doses of infused AII had no effect on renal reabsorption of sodium, in the short term, but in the long term depressed fractional proximal reabsorption. 6. Only in high doses does AII stimulate the secretion of aldosterone from the fetal adrenal. 7. Since the fetal RAS is responsible for maintenance of GFR and physiological levels of AII do not stimulate either proximal tubular sodium reabsorption nor aldosterone secretion, it is proposed that during intra-uterine life the fetal RAS maintains the renal excretion of sodium and water into the amniotic cavity, thus ensuring an adequate volume of amniotic fluid for normal growth and development.