{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T13:00:12Z","timestamp":1789822812177,"version":"4.0.1"},"reference-count":72,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T00:00:00Z","timestamp":1738108800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objective: Pre-eclampsia (PE) is a complex, advancing condition marked either by the recent emergence of hypertension and proteinuria or by the recent onset of hypertension accompanied by notable end-organ impairment, which may occur with or without proteinuria. PE usually appears in the postpartum phase or after the 20th week of gestation, though it might appear sooner in cases of molar pregnancy. Pathophysiology: This disorder is a serious multisystem condition during pregnancy that can lead to serious, life-threatening complications for both the mother and the fetus if it is not diagnosed and managed promptly. These changes result from widespread and intense vasoconstriction caused by renin, angiotensin II (Ang II), aldosterone, and catecholamines. The renin\u2013angiotensin\u2013aldosterone system (RAAS) and its sequence of signaling reactions demonstrate its crucial role in regulating blood pressure and electrolyte balance that diverges in PE from that observed in healthy pregnancies. However, it is widely recognized that the above description is incomplete for pre-eclampsia and further relationships should be analyzed. The purpose of this article is to review and synthesize alterations in renal function and the RAAS during normal pregnancy and pre-eclampsia. We aim to provide clinical gynecologists with a comprehensive understanding of how pregnancy-specific adaptations can impact renal function and the RAAS, as well as the deviations observed in pre-eclampsia. Conclusion: This information is essential to enhance clinical awareness, improve the accuracy of diagnosis, and support evidence-based decision-making in the management of pregnant patients, especially those complicated by pre-eclampsia.<\/jats:p>","DOI":"10.3390\/jcm14030892","type":"journal-article","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T07:45:12Z","timestamp":1738136712000},"page":"892","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Renal Function and the Role of the Renin\u2013Angiotensin\u2013Aldosterone System (RAAS) in Normal Pregnancy and Pre-Eclampsia"],"prefix":"10.3390","volume":"14","author":[{"given":"Panagiotis","family":"Tsikouras","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8291-5375","authenticated-orcid":false,"given":"Konstantinos","family":"Nikolettos","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0706-7918","authenticated-orcid":false,"given":"Sonia","family":"Kotanidou","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nektaria","family":"Kritsotaki","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2177-953X","authenticated-orcid":false,"given":"Efthymios","family":"Oikonomou","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3928-8489","authenticated-orcid":false,"given":"Anastasia","family":"Bothou","sequence":"additional","affiliation":[{"name":"Department of Midwifery, School of Health Sciences, University of West Attica (UNIWA), Egaleo Park Campus-28, Ag. Spyridonos Street, 12243 Egaleo, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sotiris","family":"Andreou","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theopi","family":"Nalmpanti","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyriaki","family":"Chalkia","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vlasios","family":"Spanakis","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Tsikouras","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Pagkaki","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8958-1248","authenticated-orcid":false,"given":"George","family":"Iatrakis","sequence":"additional","affiliation":[{"name":"Department of Midwifery, School of Health Sciences, University of West Attica (UNIWA), Egaleo Park Campus-28, Ag. Spyridonos Street, 12243 Egaleo, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5454-2564","authenticated-orcid":false,"given":"Christos","family":"Damaskos","sequence":"additional","affiliation":[{"name":"Department of Emergency Surgery, Laiko General Hospital, 11527 Athens, Greece"},{"name":"N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9980-0056","authenticated-orcid":false,"given":"Nikolaos","family":"Garmpis","sequence":"additional","affiliation":[{"name":"N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece"},{"name":"Department of Surgery, Sotiria General Hospital, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2260-9709","authenticated-orcid":false,"given":"Nikolaos","family":"Machairiotis","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Atticon, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Nikolettos","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.preghy.2022.01.011","article-title":"Renin-angiotensin system in normal pregnancy and in preeclampsia: A comprehensive review","volume":"28","author":"Leal","year":"2022","journal-title":"Pregnancy Hypertens."},{"key":"ref_2","first-page":"71","article-title":"LC\/MS\/MS assessment of changes in placental angiotensin I metabolism in preeclampsia","volume":"62","author":"Rytlewski","year":"2022","journal-title":"Folia Med. Cracov."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Hegazy, A., Eid, F.A., Ennab, F., Sverrisd\u00f3ttir, Y.B., Atiomo, W., and Azar, A.J. (2024). Prevalence of pre-eclampsia in women in the Middle East: A scoping review. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1384964"},{"key":"ref_4","first-page":"453","article-title":"Regulation of the human placental (pro)renin receptor-prorenin-angiotensin system by microRNAs","volume":"24","author":"Wang","year":"2018","journal-title":"Mol. Hum. Reprod."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Wu, P., Green, M., and Myers, J.E. (2023). Hypertensive disorders of pregnancy. BMJ, 381.","DOI":"10.1136\/bmj-2022-071653"},{"key":"ref_6","first-page":"293","article-title":"Clinical and Genetic Characteristics of Preeclampsia","volume":"77","author":"Golovchenko","year":"2022","journal-title":"Arch. Razi Inst."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1080\/10641955.2016.1181180","article-title":"Etiopathogenesis, prediction, and prevention of preeclampsia","volume":"35","author":"Correa","year":"2016","journal-title":"Hypertens. Pregnancy"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"104161","DOI":"10.1016\/j.jri.2023.104161","article-title":"Placenta and maternal endothelium during preeclampsia: Disruption of the glycocalyx explains increased inositol phosphoglycans and angiogenic factors in maternal blood","volume":"160","author":"Scioscia","year":"2023","journal-title":"J. Reprod. Immunol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1007\/s13730-013-0087-9","article-title":"Pregnancy in 4 women with childhood-onset steroid-sensitive nephrotic syndrome","volume":"3","author":"Motoyama","year":"2014","journal-title":"CEN Case Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1053\/j.ackd.2013.01.012","article-title":"Renal physiology of pregnancy","volume":"20","author":"Cheung","year":"2013","journal-title":"Adv. Chronic Kidney Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"F1121","DOI":"10.1152\/ajprenal.00042.2014","article-title":"The renal circulation in normal pregnancy and preeclampsia: Is there a place for relaxin?","volume":"306","author":"Conrad","year":"2014","journal-title":"Am. J. Physiol. Renal Physiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1097\/01.mnh.0000436545.94132.52","article-title":"Renal function in normal and disordered pregnancy","volume":"23","author":"Hussein","year":"2014","journal-title":"Curr. Opin. Nephrol. Hypertens."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1053\/j.ajkd.2018.06.006","article-title":"Renal Disorders in Pregnancy: Core Curriculum 2019","volume":"73","author":"Kattah","year":"2019","journal-title":"Am. J. Kidney Dis. Off. J. Natl. Kidney Found."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Stadt, M.M., West, C.A., and Layton, A.T. (2023). Effect of pregnancy and hypertension on kidney function in female rats: Modeling and functional implications. PLoS ONE., 18.","DOI":"10.1371\/journal.pone.0279785"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.disamonth.2018.03.001","article-title":"Renal complications during pregnancy: In the hypertension spectrum","volume":"65","author":"Lerma","year":"2019","journal-title":"Dis. Mon."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1053\/j.ackd.2020.07.006","article-title":"Kidney Physiology in Pregnancy","volume":"27","author":"Beers","year":"2020","journal-title":"Adv. Chronic Kidney Dis."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Andronikidi, P.E., Orovou, E., Mavrigiannaki, E., Athanasiadou, V., Tzitiridou-Chatzopoulou, M., Iatrakis, G., and Grapsa, E. (2024). Placental and Renal Pathways Underlying Pre-Eclampsia. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25052741"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2249","DOI":"10.1007\/s11255-023-03484-6","article-title":"Clinical characteristics and prognosis of pregnancy-related acute kidney injury: A case series study","volume":"55","author":"Lu","year":"2023","journal-title":"Int. Urol. Nephrol."},{"key":"ref_19","first-page":"e55544","article-title":"Physiological Changes in Pregnant Women Due to Hormonal Changes","volume":"16","author":"Jee","year":"2024","journal-title":"Cureus"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/cen.14624","article-title":"Physiological changes in pregnancy and their influence on the endocrine investigation","volume":"96","author":"Morton","year":"2022","journal-title":"Clin. Endocrinol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Maressa, V., Longhitano, E., Casuscelli, C., Di Carlo, S., Peritore, L., and Santoro, D. (2024). Pregnancy in Glomerular Disease: From Risk Identification to Counseling and Management. J. Clin. Med., 13.","DOI":"10.3390\/jcm13061693"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Binder, N.K., Beard, S., de Alwis, N., Fato, B.R., Nguyen, T.V., Kaitu\u2019u-Lino, T.J., and Hannan, N.J. (2023). Investigating the Effects of Atrial Natriuretic Peptide on the Maternal Endothelium to Determine Potential Implications for Preeclampsia. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24076182"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1007\/s00392-019-01441-x","article-title":"Role of pregnancy hormones and hormonal interaction on the maternal cardiovascular system: A literature review","volume":"108","author":"Kodogo","year":"2019","journal-title":"Clin. Res. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"R91","DOI":"10.1152\/ajpregu.00034.2013","article-title":"Roles of the circulating renin-angiotensin-aldosterone system in human pregnancy","volume":"306","author":"Lumbers","year":"2014","journal-title":"Am. J. Physiol. Regul. Integr. Comp. Physiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1152\/physrev.00023.2016","article-title":"The ACE2\/Angiotensin-(1\u20137)\/MAS Axis of the Renin-Angiotensin System: Focus on Angiotensin-(1\u20137)","volume":"98","author":"Santos","year":"2018","journal-title":"Physiol. Rev."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Bisson, C., Dautel, S., Patel, E., Suresh, S., Dauer, P., and Rana, S. (2023). Preeclampsia pathophysiology and adverse outcomes during pregnancy and postpartum. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1144170"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1002\/cphy.c200008","article-title":"Preeclampsia: Linking Placental Ischemia with Maternal Endothelial and Vascular Dysfunction","volume":"11","author":"Bakrania","year":"2020","journal-title":"Compr. Physiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.5114\/aoms.2019.87135","article-title":"Aldosterone nongenomically induces angiotensin II receptor dimerization in rat kidney: Role of mineralocorticoid receptor and NADPH oxidase","volume":"15","author":"Sinphitukkul","year":"2019","journal-title":"Arch. Med. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"7861919","DOI":"10.1155\/2016\/7861919","article-title":"Predictors of Impaired Postpartum Renal Function in Women after Preeclampsia: Results of a Prospective Single Center Study","volume":"2016","author":"Kaleta","year":"2016","journal-title":"Dis. Markers."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Xue, Y., Yang, N., Gu, X., Wang, Y., Zhang, H., and Jia, K. (2023). Risk Prediction Model of Early-Onset Preeclampsia Based on Risk Factors and Routine Laboratory Indicators. Life, 13.","DOI":"10.3390\/life13081648"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"F445","DOI":"10.1152\/ajprenal.00108.2016","article-title":"Renin-angiotensin system transgenic mouse model recapitulates pathophysiology similar to human preeclampsia with renal injury that may be mediated through VEGF","volume":"312","author":"Denney","year":"2017","journal-title":"Am. J. Physiol. Ren. Physiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"100655","DOI":"10.1016\/j.cophys.2023.100655","article-title":"Vascular and Renal Mechanisms of Preeclampsia","volume":"33","author":"Wang","year":"2023","journal-title":"Curr. Opin. Physiol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Luizon, M.R., Pereira, D.A., Mamede, I., Ceron, C.S., Cavalli, R.C., Palei, A.C., and Sandrim, V.C. (2023). Antihypertensive therapy responsiveness and adverse outcomes in preeclampsia: Insights into molecular mechanisms underlying cardiovascular and renal complications. Front. Pharmacol., 14.","DOI":"10.3389\/fphar.2023.1281382"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1007\/s11906-020-1033-9","article-title":"Preeclampsia and Glomerulonephritis: A Bidirectional Association","volume":"22","author":"Capaccio","year":"2020","journal-title":"Curr. Hypertens. Rep."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1007\/s11906-020-01098-2","article-title":"The Role of the Renin-Angiotensin-Aldosterone System in Preeclampsia: A Review","volume":"22","author":"Gathiram","year":"2020","journal-title":"Curr. Hypertens. Rep."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1204598","DOI":"10.1155\/2018\/1204598","article-title":"Aldosterone and Mineralocorticoid Receptor System in Cardiovascular Physiology and Pathophysiology","volume":"2018","author":"Cannavo","year":"2018","journal-title":"Oxid. Med. Cell. Longev."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Nehme, A., Zouein, F.A., Deris Zayeri, Z., and Zibara, K. (2019). An Update on the Tissue Renin Angiotensin System and Its Role in Physiology and Pathology. J. Cardiovasc. Dev. Dis., 6.","DOI":"10.3390\/jcdd6020014"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2243","DOI":"10.1038\/s41440-023-01356-1","article-title":"Renin-angiotensin system in the placenta of women with preeclampsia","volume":"46","author":"Mogi","year":"2023","journal-title":"Hypertens. Res. Off. J. Jpn. Soc. Hypertens."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1134\/S1607672922060011","article-title":"Regulation of the Placental Renin-Angiotensin-Aldosterone System in Early- and Late-Onset Preeclampsia","volume":"507","author":"Artemieva","year":"2022","journal-title":"Dokl. Biochem. Biophys."},{"key":"ref_40","first-page":"e40725","article-title":"Renin-Angiotensin System: Updated Understanding and Role in Physiological and Pathophysiological States","volume":"15","author":"Kanugula","year":"2023","journal-title":"Cureus"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.genm.2012.03.001","article-title":"Agonistic autoantibodies to the angiotensin II type I receptor cause pathophysiologic characteristics of preeclampsia","volume":"9","author":"LaMarca","year":"2012","journal-title":"Gend. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.coph.2011.01.003","article-title":"Role of angiotensin II type I receptor agonistic autoantibodies (AT1-AA) in preeclampsia","volume":"11","author":"LaMarca","year":"2011","journal-title":"Curr. Opin. Pharmacol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"5087","DOI":"10.1038\/s41598-017-05411-z","article-title":"The Gene Variants of Maternal\/Fetal Renin-Angiotensin System in Preeclampsia: A Hybrid Case-Parent\/Mother-Control Study","volume":"7","author":"Zhang","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Ksiazek, S.H., Hu, L., And\u00f2, S., Pirklbauer, M., S\u00e4emann, M.D., Ruotolo, C., Zara, G., Manna, G.L., Nicola, L.D., and Mayer, G. (2024). Renin\u2013Angiotensin\u2013Aldosterone System: From History to Practice of a Secular Topic. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25074035"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e012611","DOI":"10.1161\/JAHA.119.012611","article-title":"Evidence of Augmented Intrarenal Angiotensinogen Associated With Glomerular Swelling in Gestational Hypertension and Preeclampsia: Clinical Implications","volume":"8","author":"Mistry","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Shoemaker, R., Poglitsch, M., Davis, D., Huang, H., Schadler, A., Patel, N., Vignes, K., Srinivasan, A., Cockerham, C., and Bauer, J.A. (2023). Association of Elevated Serum Aldosterone Concentrations in Pregnancy with Hypertension. Biomedicines, 11.","DOI":"10.3390\/biomedicines11112954"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1007\/s11427-018-9535-9","article-title":"An alternative splicing variant of mineralocorticoid receptor discovered in preeclampsia tissues and its effect on endothelial dysfunction","volume":"63","author":"Guo","year":"2020","journal-title":"Sci. China Life Sci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"619","DOI":"10.25259\/ijmr_520_23","article-title":"AGT, CYP11B2 & ADRB2 gene polymorphism & essential hypertension (HT): A meta-analysis","volume":"159","author":"Maamor","year":"2024","journal-title":"Indian J. Med. Res."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Lumbers, E.R., Delforce, S.J., Arthurs, A.L., and Pringle, K.G. (2019). Causes and Consequences of the Dysregulated Maternal Renin-Angiotensin System in Preeclampsia. Front. Endocrinol., 10.","DOI":"10.3389\/fendo.2019.00563"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1177\/1470320313510585","article-title":"Association between urinary angiotensinogen, hypertension and proteinuria in pregnant women with preeclampsia","volume":"16","author":"Yilmaz","year":"2015","journal-title":"J. Renin-Angiotensin-Aldosterone Syst. JRAAS"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"391","DOI":"10.3892\/etm.2017.4484","article-title":"Effective prediction of preeclampsia by measuring serum angiotensin II, urinary angiotensinogen and urinary transforming growth factor \u03b21","volume":"14","author":"Zhang","year":"2017","journal-title":"Exp. Ther. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.preghy.2018.09.007","article-title":"Impact of obesity on the association of active renin and plasma aldosterone concentrations, and aldosterone-to-renin ratio with preeclampsia","volume":"14","author":"Zitouni","year":"2018","journal-title":"Pregnancy Hypertens."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Shoemaker, R., Poglitsch, M., Huang, H., Vignes, K., Srinivasan, A., Cockerham, C., Schadler, A., Bauer, J.A., and O\u2019Brien, J.M. (2023). Activation of the Renin-Angiotensin-Aldosterone System Is Attenuated in Hypertensive Compared with Normotensive Pregnancy. J. Mol. Sci., 24.","DOI":"10.3390\/ijms241612728"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2171782","DOI":"10.1080\/01443615.2023.2171782","article-title":"Pertinence between risk of preeclampsia and the renin-angiotensin-aldosterone system (RAAS) gene polymorphisms: An updated meta-analysis based on 73 studies","volume":"43","author":"Wang","year":"2023","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.preghy.2019.08.006","article-title":"Renin-angiotensin system gene variants and risk of early- and late-onset preeclampsia: A single center case-control study","volume":"18","author":"Procopciuc","year":"2019","journal-title":"Pregnancy Hypertens."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1038\/jhh.2017.29","article-title":"Are genetic polymorphisms in the renin-angiotensin-aldosterone system associated with essential hypertension? Evidence from genome-wide association studies","volume":"31","author":"Ji","year":"2017","journal-title":"J. Hum. Hypertens."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"R53","DOI":"10.1530\/JME-12-0216","article-title":"The role of the renin-angiotensin-aldosterone system in preeclampsia: Genetic polymorphisms and microRNA","volume":"50","author":"Yang","year":"2013","journal-title":"J. Mol. Endocrinol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1038\/s41371-021-00524-5","article-title":"Association of maternal angiotensin II type 1 and type 2 receptor combination genotypes with susceptibility to early-onset preeclampsia","volume":"36","author":"Satra","year":"2022","journal-title":"J. Hum. Hypertens."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1186\/s40001-024-02070-5","article-title":"Maternal and fetal neurocognitive outcomes in preeclampsia and eclampsia; a narrative review of current evidence","volume":"29","author":"Kokori","year":"2024","journal-title":"Eur. J. Med. Res."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Laresgoiti-Servitje, E., and Gomez-Lopez, N. (2012). The pathophysiology of preeclampsia involves altered levels of angiogenic factors promoted by hypoxia and autoantibody-mediated mechanisms. Biol. Reprod., 87.","DOI":"10.1095\/biolreprod.112.099861"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.mehy.2013.12.024","article-title":"The role of the renin-angiotensin system in the pathogenesis of preeclampsia\u2014New insights into the renin-angiotensin system in preeclampsia","volume":"82","author":"Seki","year":"2014","journal-title":"Med. Hypotheses"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1161\/CIRCRESAHA.122.321228","article-title":"Smooth Muscle Mineralocorticoid Receptor Promotes Hypertension After Preeclampsia","volume":"132","author":"Biwer","year":"2023","journal-title":"Circ. Res."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Gusella, A., Martignoni, G., and Giacometti, C. (2024). Behind the Curtain of Abnormal Placentation in Pre-Eclampsia: From Molecular Mechanisms to Histological Hallmarks. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25147886"},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Yart, L., Roset Bahmanyar, E., Cohen, M., and Martinez de Tejada, B. (2021). Role of the Uteroplacental Renin\u2013Angiotensin System in Placental Development and Function, and Its Implication in the Preeclampsia Pathogenesis. Biomedicines, 9.","DOI":"10.3390\/biomedicines9101332"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"95","DOI":"10.21873\/invivo.12236","article-title":"The Angiotensin-converting Enzyme Insertion\/Deletion Polymorphism as a Common Risk Factor for Major Pregnancy Complications","volume":"35","author":"Gintoni","year":"2021","journal-title":"In Vivo"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1177\/1470320312467555","article-title":"Synergistic effects of angiotensinogen -217 G\u2192A and T704C (M235T) variants on the risk of severe preeclampsia","volume":"15","author":"Shahvaisizadeh","year":"2014","journal-title":"J. Renin-Angiotensin-Aldosterone Syst."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1080285","DOI":"10.3389\/fendo.2022.1080285","article-title":"Physiological and pathological roles of Ang II and Ang- (1-7) in the female reproductive system","volume":"13","author":"Liu","year":"2022","journal-title":"Front. Endocrinol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1016\/j.ekir.2021.11.037","article-title":"Minimal Change Disease Is Associated With Endothelial Glycocalyx Degradation and Endothelial Activation","volume":"7","author":"Bauer","year":"2021","journal-title":"Kidney Int. Rep."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Booz, G.W., Kennedy, D., Bowling, M., Robinson, T., Azubuike, D., Fisher, B., Brooks, K., Chinthakuntla, P., Hoang, N.H., and Hosler, J.P. (2021). Angiotensin II type 1 receptor agonistic autoantibody blockade improves postpartum hypertension and cardiac mitochondrial function in rat model of preeclampsia. Biol. Sex. Differ., 12.","DOI":"10.1186\/s13293-021-00396-x"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1161\/HYPERTENSIONAHA.117.10681","article-title":"AT1-AA (Angiotensin II Type 1 Receptor Agonistic Autoantibody) Blockade Prevents Preeclamptic Symptoms in Placental Ischemic Rats","volume":"71","author":"Cunningham","year":"2018","journal-title":"Hypertension"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"100858","DOI":"10.1016\/j.repbio.2024.100858","article-title":"Comparative peptidomics analysis of preeclamptic placenta and the identification of a novel bioactive SERPINA1 C-terminal peptide","volume":"24","author":"Jiang","year":"2024","journal-title":"Reprod. Biol."},{"key":"ref_72","first-page":"CD008564","article-title":"Blood pressure targets for hypetension in people with chronic renal disease","volume":"10","author":"Erviti","year":"2024","journal-title":"Cochrane Database Syst. Rev."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/3\/892\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:38:18Z","timestamp":1759919898000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/3\/892"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,29]]},"references-count":72,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["jcm14030892"],"URL":"https:\/\/doi.org\/10.3390\/jcm14030892","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,29]]}}}