1. Ace Inhibitors & the Kidneys A A Jameson

2. Afferent Efferent

3. CHF ! RENIN RENIN Or Diuretic Drop in perfusion and GFR

4. CHF ! Angiotensin II Vasocontriction Increases Glomerular Pressure and Filtration

5. CHF ! Angiotensin II CHF ! ACE Inh.  C.O. Ace Inhibitors Can reverse this compensator y mechanism and shut down urine output You hope increased C.O. will restore flow

6. Early Diabetes Characterized by Hyperfiltration Normal A II tone

7. CHF ! Angiotensin II Diabetes post ACE Angiotensin constriction removed Hyperfiltration and damage reduced

8. CHF ! Angiotensin II CHF w/ renal function preserved by A II CHF w/ renal function preserved by A II Secondary benefit from Prostaglandin dilation on the supply side

9. CHF ! Angiotensin II PG

10. NSAID + ACE Drip The combination removes both the Prostaglandin dilation and the Angiotensin Efferent constriction