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Afferent arteriole Efferent arteriole. Filtrate is forced through holes in glomerular capillary walls Glomerular Filtration.

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Presentation on theme: "Afferent arteriole Efferent arteriole. Filtrate is forced through holes in glomerular capillary walls Glomerular Filtration."— Presentation transcript:

1 Afferent arteriole Efferent 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 Afferent arteriole Efferent arteriole A-II vasoconstricts predominantly the efferent arteriole Vasoconstriction increases glomerular pressure and filtration

6 A-II Efferent arteriole Afferent arteriole ACEI and ARBs remove A-II effect: efferent arteriole dilates Glomerular pressure and filtration decrease a little

7 ACEI reduces glomerular pressure and filtration of albumin remission of nephrotic syndrome due to diabetic nephropathy Ramipril 5mg daily eGFR

8 A-II Afferent arteriole Efferent arteriole Low blood pressure and vascular disease reduce pressure and flow into glomerulus Glomerular pressure and filtration decrease slowly

9 A-II Afferent arteriole Efferent arteriole Glomerular pressure and filtration suddenly decrease a lot ACEI and ARBs remove A-II effect: efferent arteriole dilates

10 -----lisinopril ramipril-- eGFR

11 : ACEI/ARB reduce pressure and slow decline in GFR. Gradual vascular narrowing 2008: Critical drop in GFR - ACEI/ARB stopped. GFR recovers 2009: Increased glomerular pressure causes proteinuria lisinopril 20mg od irbesartan 75mg od Stop both Proteinuria +++ K + = 7.5 Urea = 22 eGFR ACEI and ARBs can be good or bad for kidney function


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