afferent arteriole efferent arteriole. filtrate is forced through holes in glomerular capillary...
TRANSCRIPT
![Page 1: Afferent arteriole Efferent arteriole. Filtrate is forced through holes in glomerular capillary walls Glomerular Filtration](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a08eb5503462e378b4bc9/html5/thumbnails/1.jpg)
Afferent arteriole
Efferent arteriole
![Page 2: Afferent arteriole Efferent arteriole. Filtrate is forced through holes in glomerular capillary walls Glomerular Filtration](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a08eb5503462e378b4bc9/html5/thumbnails/2.jpg)
Filtrate is forced through holes in glomerular capillary walls
Glomerular FiltrationGlomerular FiltrationGlomerular FiltrationGlomerular Filtration
![Page 3: Afferent arteriole Efferent arteriole. Filtrate is forced through holes in glomerular capillary walls Glomerular Filtration](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a08eb5503462e378b4bc9/html5/thumbnails/3.jpg)
Glomerular capillary:Internal endothelial cell sieve; external covering of podocytes
![Page 4: Afferent arteriole Efferent arteriole. Filtrate is forced through holes in glomerular capillary walls Glomerular Filtration](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a08eb5503462e378b4bc9/html5/thumbnails/4.jpg)
Varying resistance to flow controls filtration pressure
![Page 5: Afferent arteriole Efferent arteriole. Filtrate is forced through holes in glomerular capillary walls Glomerular Filtration](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a08eb5503462e378b4bc9/html5/thumbnails/5.jpg)
A-II A-II
Afferent arteriole
Efferent arteriole
A-II vasoconstrictspredominantly the efferent arteriole
Vasoconstriction increases glomerular pressure and filtration
![Page 6: Afferent arteriole Efferent arteriole. Filtrate is forced through holes in glomerular capillary walls Glomerular Filtration](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a08eb5503462e378b4bc9/html5/thumbnails/6.jpg)
A-II A-IIEfferent arteriole
Afferent arteriole
ACEI and ARBs remove A-II effect:
efferent arteriole dilates
Glomerular pressure and filtration
decrease a little
![Page 7: Afferent arteriole Efferent arteriole. Filtrate is forced through holes in glomerular capillary walls Glomerular Filtration](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a08eb5503462e378b4bc9/html5/thumbnails/7.jpg)
ACEI reduces glomerular pressure and filtration of albumin remission of nephrotic syndrome due to diabetic nephropathy
Ramipril 5mg daily
eGFR
![Page 8: Afferent arteriole Efferent arteriole. Filtrate is forced through holes in glomerular capillary walls Glomerular Filtration](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a08eb5503462e378b4bc9/html5/thumbnails/8.jpg)
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
![Page 9: Afferent arteriole Efferent arteriole. Filtrate is forced through holes in glomerular capillary walls Glomerular Filtration](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a08eb5503462e378b4bc9/html5/thumbnails/9.jpg)
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
![Page 10: Afferent arteriole Efferent arteriole. Filtrate is forced through holes in glomerular capillary walls Glomerular Filtration](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a08eb5503462e378b4bc9/html5/thumbnails/10.jpg)
-----lisinopril-----
--ramipril--
eGFR
![Page 11: Afferent arteriole Efferent arteriole. Filtrate is forced through holes in glomerular capillary walls Glomerular Filtration](https://reader036.vdocuments.site/reader036/viewer/2022062511/551a08eb5503462e378b4bc9/html5/thumbnails/11.jpg)
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