Kidneys confuse new FNP. One professor taught us about them using an M&M analogy which seemed to work for other people, but never quite sat with me. New FNP didn't totally care that she was missing something because we got to eat M&M's (big boy and little boy), which was stupendous. But here new FNP sits, listening to Death Cab and wondering about kidneys, ACE Inhibitors and just having an overall "what the fuck" moment.
So, the major messages new FNP has cemented about ACE Inhibitors is that A) they give you a cough; B) diabetics with microalbuminuria need them; C) check the K+ and; D they are a big no-no in renal disease, specifically bilateral renal artery stenosis. Even thinking about this at 9:00 PM gives me hives. What new FNP didn't understand this AM when she saw her 1st patient of the day was why ACE I's protect kidneys in one instance yet harm them even more in another. Well, new FNP has the answer for those interested in specializing in nephrology - although why, why, why would you?
Anyway, diabetic nephropathy is likely prevented with an ACE as a result of the decreased glomerular efferent arteriolar resistance (can we call it GEAR??) and a reduction in intra-glomerular capillary pressure, thereby preserving GFR, improving renal hemodynamics and diminishing proteinuria. In renal artery stenosis, the vasodilating effect of the ACE prevents the kidney from maintaining perfusion, thus leading to ischemia. This is all from my textbook, by the way. I still don't totally understand, but if I try to picture a stenotic renal artery, I can begin to get it a little more. New FNP is open to taking help from students of the kidney. Please, e-mail away.
- add pre-, intra-, and post-renal causes of renal dysfunction to the "to learn" list. What new FNP really needs to learn where a Sigerson Morrison store is in the town, because when new FNP is stressed, she needs cute shoes.
New FNP saw 16 patients today and, amazingly, was not utterly destroyed at the end of the day. Poco a poco, as we say in the clinic when we are talking about dietary and lifestyle change at every flippin' diabetes visit. Little by little.