cardiorenal syndrome
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Introduction
renal insufficiency in the setting of acute heart failure
Classification
- acute heart failure leading to acute renal failure
- chronic heart failure leading to chronic renal failure
- acute renal failure leading to acute heart failure
- chronic renal failure leading to chronic heart failure, coronary artery disease or cardiac arrhythmias
- systemic conditions leading to simultaneous heart failure & renal failure (i.e. sepsis)
Pathology
- elevated renal vein pressure -> distended renal venules -> increased renal tubule pressure & backleak
Clinical manifestations
- diuretic-resistant congestive heart failure
- acute renal failure
- worsening renal function with heart failure treatment[1]
Laboratory
- serum creatinine commonly increases with treatment of hypervolemia until fluid balance is achieved
Complications
- mainstay of treatment for volume overload in patients with acute heart failure, diuretics, can worsen renal function
Management
- general measures
- discontinue diuretics
- sodium restriction
- treatment with vasocontrictors
- infusion of albumin[1]
- loop diuretics for volume overload (see laboratory)
- do not increase beta-blocker during acute heart failure
- ultrafiltration may be useful in patients who have not responded (with diuresis) to diuretics[1]
- nesiritide of no benefit
- aortic valve replacement can improve renal function in patients with aortic valve disease[6]
More general terms
References
- ↑ 1.0 1.1 1.2 1.3 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018, 2021.
- ↑ Bart BA et al. Ultrafiltration in decompensated heart failure with cardiorenal syndrome. N Engl J Med 2012 Nov 6; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23131078 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1210357
- ↑ Ronco C, Haapio M, House AA, Anavekar N, Bellomo R. Cardiorenal syndrome. J Am Coll Cardiol. 2008 Nov 4;52(19):1527-39. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19007588
- ↑ Bock JS, Gottlieb SS Cardiorenal syndrome: new perspectives. Circulation. 2010 Jun 15;121(23):2592-600 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20547939
- ↑ Verbrugge FH, Grieten L, Mullens W. Management of the cardiorenal syndrome in decompensated heart failure. Cardiorenal Med. 2014 Dec;4(3-4):176-88. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25737682 Free PMC Article
- ↑ 6.0 6.1 Witberg G, Steinmetz T, Landes U et al Change in Kidney Function and 2-Year Mortality After Transcatheter Aortic Valve Replacement. JAMA Netw Open. 2021;4(3):e213296. March 26 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33769507 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2777870
Galper BZ Can Transcatheter Aortic Valve Replacement Cure Cardiorenal Syndrome? JAMA Netw Open. 2021;4(3):e213753. March 26 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33769503 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2777866