Figure 1414

Kidney Function Restoration Program

Most Effective Kidney Damage Treatments

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Prostacyclin is important in maintaining renal blood flow (RBF) and glomerular filtration rate (GFR) in "prerenal" states. A, When intravascular volume is normal, prostacyclin production in the endothelial cells of the kidney is low and prostacyclin plays little or no role in control of vascular tone. B, The reduction in absolute or "effective" arterial blood volume associated with all prerenal states leads to an increase in the circulating levels of a number of of vasoconstrictors, including angiotensin II, catecholamines, and vasopressin. The increase in vasoconstrictors stimulates phospholipase A2 and prostacyclin production in renal endothelial cells. This increase in prostacyclin production partially counteracts the effects of the circulating vasoconstrictors and plays a critical role in maintaining normal or nearly normal RBF and GFR in prerenal states. C, The effect of cycloxygenase inhibition with nonsteroidal anti-inflammatory drugs (NSAIDs) in prerenal states. Inhibition of prostacyclin production in the presence of intravascular volume depletion results in unopposed action of prevailing vasoconstrictors and results in severe intrarenal vascasoconstric-tion. NSAIDs can precipitate severe acute renal failure in these situations.

A. VASODILATORS USED IN EXPERIMENTAL ACUTE RENAL FAILURE (ARF)

Vasodilator

ARF Disorder

Time Given in Relation to Induction

Observed Effect

Propranolol

Ischemic

Before, during, after

┬┐Scr, BUN if given before,

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