Afferent arteriole

1
Efferent arteriole
Afferent arteriole
2
Filtrate is forced through holes in glomerular
capillary walls
Glomerular Filtration
3
Glomerular capillary Internal endothelial cell
sieve external covering of podocytes
4
Varying resistance to flow controls filtration
pressure
5
A-II vasoconstricts predominantly the efferent
arteriole
Efferent arteriole
Vasoconstriction increases glomerular pressure
and filtration
Afferent arteriole
6
ACEI and ARBs remove A-II effect efferent
arteriole dilates
Efferent arteriole
Glomerular pressure and filtration decrease a
little
Afferent arteriole
7
ACEI reduces glomerular pressure and filtration
of albumin? remission of nephrotic syndrome due
to diabetic nephropathy
eGFR
8
Low blood pressure and vascular disease reduce
pressure and flow into glomerulus
Efferent arteriole
A-II
A-II
Glomerular pressure and filtration decrease slowly
Afferent arteriole
9
ACEI and ARBs remove A-II effect efferent
arteriole dilates
Efferent arteriole
Glomerular pressure and filtration suddenly
decrease a lot
Afferent arteriole
10

eGFR
-----lisinopril-----
--ramipril--
11
1997-2008 ACEI/ARB reduce pressure and slow
decline in GFR. Gradual vascular narrowing2008
Critical drop in GFR - ACEI/ARB stopped. GFR
recovers2009 Increased glomerular pressure
causes proteinuria

eGFR
ACEI and ARBs can be good or bad for kidney
function
lisinopril 20mg od
irbesartan 75mg od
Stop both
Proteinuria
K 7.5 Urea 22