HORMONES, AUTACOIDS, NEUROTRANSMITTERS AND GROWTH FACTORS: Edited by Mark Cooper and Merlin ThomasAngiotensin-converting enzyme 2 and renal diseaseWilliams, Vanessa R.a,b; Scholey, James W.a,bAuthor Information aInstitute of Medical Science, Faculty of Medicine, University of Toronto bDivision of Nephrology, Department of Medicine, University Health Network, Toronto, Canada Correspondence to Vanessa R. Williams, Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 4368, Toronto, ON M5S 1A8, Canada. Tel: +1 416 978 6870; fax: +1 416 978 8765; e-mail: firstname.lastname@example.org Current Opinion in Nephrology and Hypertension: January 2018 - Volume 27 - Issue 1 - p 35-41 doi: 10.1097/MNH.0000000000000378 Buy Metrics Abstract Purpose of review The renin–angiotensin system (RAS) is a pivotal player in the physiology and pathophysiology of cardiovascular and renal systems. Discovery of angiotensin-converting enzyme 2 (ACE2), capable of cleaving RAS effector peptide angiotensin (Ang) II into biologically active Ang-(1–7), has increased the complexity of our knowledge of the RAS. ACE2 expression is abundant in the kidney and is thought to provide protection against injury. This review emphasizes current experimental and clinical findings that examine ACE2 in the context of kidney injury and its potential therapeutic impact for treatment of kidney disease. Recent findings Clinical studies have reported upregulation of ACE2 in urine from diabetic patients, which may be reflective of pathological shedding of renal ACE2 as suggested by mechanistic experiments. Studies in experimental models have investigated the feasibility of pharmacological induction of ACE2 for improvement of renal function, inflammation, and fibrosis. Summary Emerging concepts about the RAS indicate that ACE2 is a critical regulator of angiotensin peptide metabolism and the pathogenesis of renal disease. Human recombinant ACE2 is available and may be a practical clinical approach to enzyme replacement. Elucidating precise roles of ACE2 throughout disease progression will enrich our view of the RAS and help identify novel targets and appropriate strategies for intervention. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.