Ace Inhibitors & the Kidneys
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Transcript of Ace Inhibitors & the Kidneys
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Ace Inhibitors & the Kidneys
A A
Jameson
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Afferent
Efferent
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CHF !CHF !
RENINRENIN
Or Diuretic
Drop in perfusion and GFR
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CHF !CHF ! Angiotensin II
VasocontrictionIncreases Glomerular Pressure and Filtration
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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
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Early DiabetesEarly Diabetes
Characterized by Hyperfiltration
Normal A II tone
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CHF !CHF ! Angiotensin II
Diabetes post ACEDiabetes post ACE
Angiotensin constriction removed
Hyperfiltration and damage reduced
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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
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CHF !CHF ! Angiotensin II
PG
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NSAID + ACENSAID + ACE
DripThe combination removes both the Prostaglandin dilation and the Angiotensin Efferent constriction