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so were thinking about the angiotensin Renan aldosterone system and this is a fascinating example of how physiology and pathophysiology interrelate now physiologically of course youve got your kidney and its essential to have an adequate blood supply to the kidney the kidneys need theyre going to need a good blood supply to filter the blood clean the blood produce the urine now if for any reason cardiac output drops remember our diagram from the last video when we were thinking about heart failure heart failure here if theres myocyte loss fibrosis of myocytes that causes the heart failure thats going to reduce cardiac output the volume of blood pumped out by the heart in a one-minute period so if theres a reduction in cardiac output theres going to be a reduction in renal perfusion so reduced cardiac output its going to lead to reduced renal perfusion now if theres less blood going to the kidneys whats that going to do to the pressure of the blood within the kidneys themselv