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