Afferent arteriole Efferent arteriole. Filtrate is forced through holes in glomerular capillary...
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Transcript of Afferent arteriole Efferent arteriole. Filtrate is forced through holes in glomerular capillary...
Afferent arteriole
Efferent arteriole
Filtrate is forced through holes in glomerular capillary walls
Glomerular FiltrationGlomerular FiltrationGlomerular FiltrationGlomerular Filtration
Glomerular capillary:Internal endothelial cell sieve; external covering of podocytes
Varying resistance to flow controls filtration pressure
A-II A-II
Afferent arteriole
Efferent arteriole
A-II vasoconstrictspredominantly the efferent arteriole
Vasoconstriction increases glomerular pressure and filtration
A-II A-IIEfferent arteriole
Afferent arteriole
ACEI and ARBs remove A-II effect:
efferent arteriole dilates
Glomerular pressure and filtration
decrease a little
ACEI reduces glomerular pressure and filtration of albumin remission of nephrotic syndrome due to diabetic nephropathy
Ramipril 5mg daily
eGFR
A-II A-II
Afferent arteriole
Efferent arteriole
Low blood pressure and vascular disease reduce
pressure and flow into glomerulus
Glomerular pressure and filtration
decrease slowly
A-II A-II
Afferent arteriole
Efferent arteriole
Glomerular pressure and filtration suddenly
decrease a lot
ACEI and ARBs remove A-II effect:
efferent arteriole dilates
-----lisinopril-----
--ramipril--
eGFR
1997-2008: ACEI/ARB reduce pressure and slow decline in GFR. Gradual vascular narrowing2008: Critical drop in GFR - ACEI/ARB stopped. GFR recovers
2009: Increased glomerular pressure causes proteinuria
lisinopril 20mg od
irbesartan 75mg odStop both
Proteinuria +++
K+ = 7.5Urea = 22
eGFRACEI and ARBs can be
good or badfor kidney function