BNP physiology and factors affecting levels (obesity, renal function, age, gender)
Core concept
- Released from ventricular myocytes in response to WALL STRESS (stretch), not to volume per se
- preproBNP -> proBNP -> cleaved by corin/furin -> BNP (active, 32 aa) + NT-proBNP (inactive, 76 aa)
- Actions oppose RAAS: natriuresis, diuresis, vasodilatation, dec sympathetic tone, antifibrotic, antihypertrophic
- Clearance is the key difference between the two assays
| BNP | NT-proBNP | |
|---|---|---|
| Half-life | ~20 min | ~60-120 min |
| Clearance | NPR-C receptor + neprilysin | Passive renal |
| Effect of renal failure | inc | inc more |
| Sacubitril/valsartan | *BNP RISES* (neprilysin inhibited) | Falls - use NT-proBNP to monitor |
3 more sections, plus exam facts
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