Ace Inhibitors & the Kidneys

A A

Jameson

Afferent

Efferent

CHF !CHF !

RENINRENIN

Or Diuretic

Drop in perfusion and GFR

CHF !CHF ! Angiotensin II

VasocontrictionIncreases Glomerular Pressure and Filtration

CHF !CHF ! Angiotensin IICHF !CHF !

ACE Inh.

C.O.

Ace Inhibitors

Can reverse this compensatory mechanism and shut down urine output

You hope increased C.O. will restore flow

Early DiabetesEarly Diabetes

Characterized by Hyperfiltration

Normal A II tone

CHF !CHF ! Angiotensin II

Diabetes post ACEDiabetes post ACE

Angiotensin constriction removed

Hyperfiltration and damage reduced

CHF !CHF ! Angiotensin IICHF w/ renal function

preserved by A II

CHF w/ renal functionpreserved by A II

Secondary benefit from Prostaglandin dilation on the supply side

CHF !CHF ! Angiotensin II

PG

NSAID + ACENSAID + ACE

DripThe combination removes both the Prostaglandin dilation and the Angiotensin Efferent constriction