Post on 07-Jan-2016
description
Ace Inhibitors & the Kidneys
A A
Jameson
Afferent
Efferent
CHF !CHF !
RENINRENIN
Or Diuretic
Drop in perfusion and GFR
CHF !CHF ! Angiotensin II
VasocontrictionIncreases Glomerular Pressure and Filtration
CHF !CHF ! Angiotensin IICHF !CHF !
ACE Inh.
C.O.
Ace Inhibitors
Can reverse this compensatory mechanism and shut down urine output
You hope increased C.O. will restore flow
Early DiabetesEarly Diabetes
Characterized by Hyperfiltration
Normal A II tone
CHF !CHF ! Angiotensin II
Diabetes post ACEDiabetes post ACE
Angiotensin constriction removed
Hyperfiltration and damage reduced
CHF !CHF ! Angiotensin IICHF w/ renal function
preserved by A II
CHF w/ renal functionpreserved by A II
Secondary benefit from Prostaglandin dilation on the supply side
CHF !CHF ! Angiotensin II
PG
NSAID + ACENSAID + ACE
DripThe combination removes both the Prostaglandin dilation and the Angiotensin Efferent constriction