DOCSLIB.ORG

Cardiohepatic Syndrome

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Cardiohepatic Syndrome Organ dysfunction in acute heart failure: Cardio-hepatic syndrome Alexandre Mebazaa Department of Anesthesia & Critical Care University Hospitals Saint Louis – Lariboisière, Paris, France University Paris 7; INSERM – UMR 942 Conflict of interest • Speaker’s bureau Alere, Edwards, Thermofischer • Consultant for Bayer, Cardiorentis, Novartis, Orion, Vifor Pharma Online, free access Short version: HFA/EUSEM/SAEM Eur Heart Journal 2015; Long version: Eur J Heart Failure 2015 ‘Clinical scenario 2’ in the CCU: dyspnoea + SBP 110-150 mmHg Decompensated chronic heart failure • Dyspnoea develops gradually • Gradual increase in body weight • Systemic oedema • Minimal pulmonary oedema It is a systemic illness: • Possible renal dysfunction • Anaemia • Low albumin levels • Increased pulmonary congestion • Systemic congestion Acute heart failure = right & left ventricular failure: results of meta-analysis LV failure RAP - right atrial pressure PCWP - pulmonary capillary wedge pressure Ishihara S et al (submitted for publication) “Butterfly” pattern on chest X-ray Monnier-Cholley L Chest X-ray in Acute Heart Failure in Mebazaa A et al (Eds) Acute Heart Failure (2009) Springer Science & Business Media Acute heart failure = right & left ventricular failure: results of meta-analysis RV failure RAP - right atrial pressure PCWP - pulmonary capillary wedge pressure Ishihara S et al (submitted for publication) Cardiorenal Syndrome Type I ? Acute setting ? ‘abrupt worsening of cardiac function (e.g. from ADHF) leading to acute kidney injury’ Ronco et al. JACC 2008, 52:1527-39 Ronco C et al. J Am Coll Card 2008, 52:1527-39 Effects of CVP, CI, SBP and PcwP on worsening renal function In Acute Heart Failure patients CVP (p<0.01) CI SBP PCWP Worsening Renal Function (%) Mullens et al. JACC 2009, 53:589-596 Association between baseline creatinine level and invasive haemodynamics in AHF: results of a meta-analysis p=0.30 p=0.006 p=0.58 p=0.007 Ishihara S et al (submitted for publication) Gheorghiade et al. Eur J Heart F 2010 Abstract of the review « The main reason for hospitalization for acute heart failure is CONGESTION, rather than low cardiac output ». Gheorghiade et al. Eur J Heart F 2010 Several interactions have been described in acute heart failure - Cardio-renal syndromes - Cardio-liver syndrome(s) ??? EFICA Laboratory Tests on Admission Zannad F, Mebazaa A, et al. Eur J Heart Fail. 2006 EFICA Risk Factors of 4-week Mortality Zannad F, Mebazaa A, et al. Eur J Heart Fail. 2006 DANGER Mechanical ventilation can worsen liver congestion • 38 y.o. man, dilated cardiomyopathy • referred to the emergency room for shortness of breath • predominant right heart failure • major hepatic cytolysis (AST: 10000 IU/l; ALT: 5000); lactate: 5.4 mmol/L; PT 35% • Renal failure Gatecel et al. Anesthesiology, 1995, 82:588 Mechanical ventilation can worsen liver congestion Gatecel et al. Anesthesiology, 1995, 82:588 Mechanical ventilation can worsen liver congestion Gatecel et al. Anesthesiology, 1995, 82:588 Arterial pressure Normal Intra-tissular pressure = 0 Outflow pressure Effect of Heart MAP > Tissular pressure Failure Stable on Organ CHF Congestion MAP < Tissular pressure AHF ± high PAP volume loading PA RAP ARVF TR RV Liver/Kidney CONGESTION Liver dysfunction in AHF: Clinical characteristics Alk Phosphatase Transaminases normal abnormal normal abnormal (22%) (37%) Nikolaou et al Eur Heart Journal 2013 6-month mortality as a function of liver cytolysis Nikolaou et al Eur Heart Journal 2013 6-month mortality as a function of cholestatis Nikolaou et al Eur Heart Journal 2013 AHF-induced liver congestion (increased BNP) Normal bile duct bile duct liver lobule compression compression (increased AP) (increased AP) + + + +++ +++ + + and cytolysis (increased transaminanses) Nikolaou et al Eur Heart Journal 2013 AHF-induced liver congestion (increased BNP) Normal bile duct bile duct liver lobule compression compression (increased AP) (increased AP) + + + +++ +++ + + and cytolysis (increased transaminanses) Nikolaou et al Eur Heart Journal 2013 Factors associated with elevated alkaline phosphatase Nikolaou et al Eur Heart Journal 2013 ALARM-HF: IV treatment at admission inotropes Mebazaa et al Intensive Care Medicine 2011 0.6 Epinephrine 0.5 Norepinephrine 0.4 0.3 Dopamine Dobutamine 0.2 In-hospital mortality Whole cohort Diuretics 0.1 Levosimendan 0.0 Vasodilatators 0 5 10 15 20 25 30 Days Online, free access HFA/EUSEM/SAEM Eur Heart Journal 2015 What to do in the first 30-60 min (1) HFA/EUSEM/SAEM Eur Heart Journal 2015 What to do in the first 30-60 min (1) SEVERITY SCORE HFA/EUSEM/SAEM Eur Heart Journal 2015 Next 120 min HFA/EUSEM/SAEM Eur Heart Journal 2015 Admission/ discharge HFA/EUSEM/SAEM Eur Heart Journal 2015 Main messages (1) •Congestion is the main disease in acute heart failure •Novel therapies, such as novel vasodilators, aim at reducing congestion •« time is muscle « Main messages (2) •There are evidence for a cardio-liver syndrome in AHF •Cholestasis is associated with signs of congestion •Hepatolysis is associated with decreased blood flow In summary • There are evidence for a cardio-liver syndrome in AHF • Cholestasis is associated with signs of congestion • Hepatolysis is associated with decreased blood flow.
Load more

Recommended publications
  • Cardiorenal Syndrome in Patients with Heart Failure
    CARDIORENAL SYNDROME IN PATIENTS WITH HEART FAILURE IN KANO. A DISSERTATION SUBMITTED TO THE NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE AWARD OF FELLOWSHIP OF THE COLLEGE IN INTERNAL MEDICINE (CARDIOLOGY). BY DR MUHAMMAD NAZIR SHEHU M.B, B.S [B.U.K.] 2002 DEPARTMENT OF MEDICINE AMINU KANO TEACHING HOSPITAL, KANO. MAY 2014 i DECLARATION I hereby declare that this work is original unless otherwise acknowledged. This work has not been presented to any other College for Fellowship and has not been submitted elsewhere for publication. Signature---------------------------- Date---------------------- DR MUHAMMAD NAZIR SHEHU May 2014 ii CERTIFICATION I SUPERVISORS’ CERTIFICATION This study reported in this Dissertation was done by the candidate under our supervision. We also supervised the writing of the Dissertation. SUPERVISOR 1. SIGNATURE/DATE:……………………………………………….. Professor SA Isezuo (FMCP) Professor of Medicine and Consultant Physician/Cardiologist, Usman Danfodiyo University Teaching Hospital,Sokoto. 2. SIGNATURE/DATE:……………………………………………….. Professor B. N. Okeahialam, (FWACP). Professor of Medicine and Consultant Physician/Cardiologist, Jos University Teaching Hospital, Jos, Plateau State, Nigeria. 3. SIGNATURE/DATE:------------------------------------------------------- DR M. M. BORODO (FMCP) Associate Professor of Medicine and Consultant Physician/Gastroenterologist, Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria. iii CERTIFICATION II HEAD OF DEPARTMENT’S CERTIFICATION This
    [Show full text]
  • Future Diagnostic & Therapeutic Targets in Cardiorenal Syndromes
    Future Diagnostic & Therapeutic Targets in Cardiorenal Syndromes (Biomarkers, advanced monitoring, advanced imaging, novel therapies) EDGAR V. LERMA, MD Clinical Professor of Medicine Secon of Nephrology UIC/ Advocate Christ Medical Center Oak Lawn, IL May 27, 2017 Disclosure of Interests • Honoraria: UpToDate, McGraw-Hill Publishing, Elsevier Publishing, Springer Publishing, Wolters-Kluwer Publishing, ACP Smart Medicine, Emedicine • Editorial Boards: American Journal of Kidney Diseases, ASN Kidney News, Clinical Journal of the American Society of Nephrology, Clinical Reviews in Bone and Mineral Metabolism, International Urology and Nephrology, Journal of Clinical Lipidology, Prescribers Letter, Renal and Urology News, Reviews in Endocrinology and Metabolic Disorders, Seminars in Dialysis • Speaker/ Advisory Board: Astute Medical, Mallinckrodt, Otsuka Pharmaceuticals, ZS Pharma KDIGO Controversies Conference on Heart Failure in CKD May 25-28, 2017 | Athens, Greece Disclosure of ABIM Service: Edgar V. Lerma, M.D. ▪ I am a current member of the ABIM Self-Assessment Committee. ▪ To protect the integrity of certification, ABIM enforces strict confidentiality and ownership of exam content. ▪ My participation in this CME activity is allowed under ABIM policy and is subject to the following: • As a member of an ABIM test committee, I agreed to keep exam information confidential, as it is owned exclusively by ABIM. • As is true for any ABIM candidate who has taken an exam for certification, I have signed the Pledge of Honesty in which I have agreed
    [Show full text]
  • Cardio-Renal Syndrome
    Kelly Li RSC Symposium 2017 . 40-50% of patients with HF have co-existing CKD (GFR<60) . Reductions in GFR strongly affect all-cause mortality in HF patients . CKD is a powerful independent risk factor for the development and progression of CVD and outcomes . >60% CKD patients have CVD, and degree of CVD correlates with CKD severity . Patients with stage 3 or higher CKD have a threefold higher risk of HF . Systemic disorders can cause both cardiac and renal dysfunction Schefold et al Nature Reviews Nephrology 2016 Comorbid conditions at end of year Australia 40 30 20 % % of patients Coronary 10 Peripheral vascular Lung Cerebrovascular 0 2005 2007 2009 2011 2013 2015 Suspected cases included 2016 ANZDATA Annual Report, Figure 2.10 Cause of death Deaths occurring during 2015 Australia New Zealand 100 80 60 Percent 40 20 0 HD PD Tx HD PD Tx Cardiovascular Withdrawal Cancer Infection Other 2016 ANZDATA Annual Report, Figure 3.5 Wali et al JACC 2005 Figure 2. Kaplan-Meier plot of cumulative incidence of cardiovascular death or unplanned admission to hospital for the management of worsening CHF stratified by approximate quintiles of eGFR in mL/min per 1.73 m2 (time in years). Hillege et al Circulation 2016 Schefold et al Nature Reviews Nephrology 2016 Schefold et al Nature Reviews Nephrology 2016 . Cardiorenal syndrome complex and bi-directional . Haemodynamic interactions . Neurohormonal dysregulation . Inflammation and other metabolic changes Schefold et al Nature Reviews Nephrology 2016 Schefold et al Nature Reviews Nephrology 2016 Schefold et al Nature Reviews Nephrology 2016 Schefold et al Nature Reviews Nephrology 2016 Schefold et al Nature Reviews Nephrology 2016 Schefold et al Nature Reviews Nephrology 2016 Schefold et al Nature Reviews Nephrology 2016 Schefold et al Nature Reviews Nephrology 2016 Schefold et al Nature Reviews Nephrology 2016 .
    [Show full text]
  • Cardiorenal Syndrome: Emerging Role of Medical Imaging for Clinical Diagnosis and Management
    Journal of Personalized Medicine Review Cardiorenal Syndrome: Emerging Role of Medical Imaging for Clinical Diagnosis and Management Ling Lin 1 , Xuhui Zhou 2,* , Ilona A. Dekkers 1 and Hildo J. Lamb 1 1 Cardiovascular Imaging Group (CVIG), Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; [email protected] (L.L.); [email protected] (I.A.D.); [email protected] (H.J.L.) 2 Department of Radiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 510833, China * Correspondence: [email protected]; Tel.: +86-755-83982222 Abstract: Cardiorenal syndrome (CRS) concerns the interconnection between heart and kidneys in which the dysfunction of one organ leads to abnormalities of the other. The main clinical challenges associated with cardiorenal syndrome are the lack of tools for early diagnosis, prognosis, and evaluation of therapeutic effects. Ultrasound, computed tomography, nuclear medicine, and magnetic resonance imaging are increasingly used for clinical management of cardiovascular and renal diseases. In the last decade, rapid development of imaging techniques provides a number of promising biomarkers for functional evaluation and tissue characterization. This review summarizes the applicability as well as the future technological potential of each imaging modality in the assessment of CRS. Furthermore, opportunities for a comprehensive imaging approach for the evaluation of CRS are defined. Citation: Lin, L.; Zhou, X.; Dekkers, Keywords: cardiorenal syndrome; imaging biomarker; tissue characterization I.A.; Lamb, H.J. Cardiorenal Syndrome: Emerging Role of Medical Imaging for Clinical Diagnosis and Management. J. Pers. Med. 2021, 11, 1. Introduction 734. https://doi.org/10.3390/ Cardiorenal syndrome (CRS) is an umbrella term describing the interactions between jpm11080734 concomitant cardiac and renal dysfunctions, in which acute or chronic dysfunction of one organ may induce or precipitate dysfunction of the other [1].
    [Show full text]
  • Cardiorenal Syndrome
    Journal of the American College of Cardiology Vol. 52, No. 19, 2008 © 2008 by the American College of Cardiology Foundation ISSN 0735-1097/08/$34.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2008.07.051 STATE-OF-THE-ART PAPER Cardiorenal Syndrome Claudio Ronco, MD,* Mikko Haapio, MD,† Andrew A. House, MSC, MD,‡ Nagesh Anavekar, MD,§ Rinaldo Bellomo, MD¶ Vicenza, Italy; Helsinki, Finland; London, Ontario, Canada; and Melbourne, Australia The term cardiorenal syndrome (CRS) increasingly has been used without a consistent or well-accepted defini- tion. To include the vast array of interrelated derangements, and to stress the bidirectional nature of heart- kidney interactions, we present a new classification of the CRS with 5 subtypes that reflect the pathophysiology, the time-frame, and the nature of concomitant cardiac and renal dysfunction. CRS can be generally defined as a pathophysiologic disorder of the heart and kidneys whereby acute or chronic dysfunction of 1 organ may induce acute or chronic dysfunction of the other. Type 1 CRS reflects an abrupt worsening of cardiac function (e.g., acute cardiogenic shock or decompensated congestive heart failure) leading to acute kidney injury. Type 2 CRS comprises chronic abnormalities in cardiac function (e.g., chronic congestive heart failure) causing progressive chronic kidney disease. Type 3 CRS consists of an abrupt worsening of renal function (e.g., acute kidney isch- emia or glomerulonephritis) causing acute cardiac dysfunction (e.g., heart failure, arrhythmia, ischemia). Type 4 CRS describes a state of chronic kidney disease (e.g., chronic glomerular disease) contributing to decreased car- diac function, cardiac hypertrophy, and/or increased risk of adverse cardiovascular events.
    [Show full text]
  • Heart Failure
    Heart Failure Peter A. McCullough, MD, MPH, FACC, FACP, FAHA, FCCP Consultant Cardiologist, Chief Academic and Scientific Officer St. John Providence Health System Providence Park Heart Institute Novi, MI USA e-mail: [email protected] Outline Definitions Complex, bidirectional pathogenesis Example of novel target Therapy Putting it all together Outline Definitions Complex, bidirectional pathogenesis Example of novel target Therapy Putting it all together Definition of Heart Failure (HF) •• TheThe failure of the heart as a pump resulting in inadequate cardiac output to peripheral tissues and stasis of blood in the lungs resulting most commonly in fatigue and pulmonary congestion.congestion. •• A complex mechanical and neurohumoral syndrome characterized by effort intolerance, fluid retention, and reduced longevity. •• At least 7 definitions in the literature based on tested scoring schemes and expert opinion. Heart Failure as a Clinical Clinical presentationSyndrome of acute kidney injury Stasis of blood, tissue deposition of water and salt resulting in effort intolerance, progressive dyspnea, fatigue, edema Definition and Classification of the Cardio-Renal Syndromes Cardio-Renal Syndromes (CRS) General Definition: Disorders of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other Acute Cardio-Renal Syndrome (Type 1) Acute worsening of cardiac function leading to renal dysfunction Chronic Cardio-Renal Syndrome (Type 2) Chronic abnormalities in cardiac
    [Show full text]
  • Amiodarone-Induced Hypothyroidism Presenting As Cardiorenal Syndrome
    Hindawi Publishing Corporation Case Reports in Cardiology Volume 2012, Article ID 161450, 3 pages doi:10.1155/2012/161450 Case Report Amiodarone-Induced Hypothyroidism Presenting as Cardiorenal Syndrome Evan L. Hardegree1 and Robert C. Albright2 1 Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA 2 Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA CorrespondenceshouldbeaddressedtoEvanL.Hardegree,[email protected] Received 6 March 2012; Accepted 14 May 2012 Academic Editors: H. Kitaoka and A. J. Mansur Copyright © 2012 E. L. Hardegree and R. C. Albright. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Here we present the case of a 90-year-old man with chronic heart and renal failure who was admitted with what appeared to be a simple heart failure exacerbation. However, further investigation led to the diagnosis of profound amiodarone-induced hypothy- roidism as the cause of his acute decompensation, highlighting the importance of a broad differential diagnosis and thorough investigation. 1. Introduction (LVEF) of 15% with a dual-chamber pacemaker for car- diac resynchronization; paroxysmal atrial fibrillation and In patients with concurrent heart and renal failure (cardiore- frequent ven-tricular ectopy requiring initiation of amio- nal syndrome), common causes of decompensation may in- darone 6 months prior (200 mcg/day); stage IV chronic clude myocardial ischemia, excessive salt ingestion, and med- kidney disease, not on dialysis. The patient reported full ication noncompliance. However, there are many conditions compliance with his medical heart failure regimen and that may tip this delicate balance.
    [Show full text]
  • Cardiorenal Syndrome in Thalassemia Patients
    Makmettakul et al. BMC Nephrology (2020) 21:325 https://doi.org/10.1186/s12882-020-01990-8 RESEARCH ARTICLE Open Access Cardiorenal syndrome in thalassemia patients Sorasak Makmettakul1,2, Adisak Tantiworawit1* , Arintaya Phrommintikul3, Pokpong Piriyakhuntorn1, Thanawat Rattanathammethee1, Sasinee Hantrakool1, Chatree Chai-Adisaksopha1, Ekarat Rattarittamrong1, Lalita Norasetthada1, Kanda Fanhchaksai4 , Pimlak Charoenkwan4 and Suree Lekawanvijit5 Abstract Background: Cardiorenal syndrome (CRS), a serious condition with high morbidity and mortality, is characterized by the coexistence of cardiac abnormality and renal dysfunction. There is limited information about CRS in association thalassemia. This study aimed to investigate the prevalence of CRS in thalassemia patients and also associated risk factors. Methods: Thalassemia patients who attended the out-patient clinic of a tertiary care university hospital from October 2016 to September 2017 were enrolled onto this cross-sectional study. Clinical and laboratory findings from 2 consecutive visits, 3 months apart, were assessed. The criteria for diagnosis of CRS was based on a system proposed by Ronco and McCullough. Cardiac abnormalities are assessed by clinical presentation, establishment of acute or chronic heart failure using definitions from 2016 ESC guidelines or from structural abnormalities shown in an echocardiogram. Renal dysfunction was defined as chronic kidney disease according to the 2012 KDIGO guidelines. Results: Out of 90 thalassemia patients, 25 (27.8%) had CRS. The multivariable analysis showed a significant association between CRS and extramedullary hematopoiesis (EMH) (odds ratio (OR) 20.55, p = 0.016); thalassemia type [β0/βE vs β0/β0 thalassemia (OR 0.005, p = 0.002)]; pulmonary hypertension (OR 178.1, p = 0.001); elevated serum NT-proBNP (OR 1.028, p = 0.022), and elevated 24-h urine magnesium (OR 1.913, p = 0.016).
    [Show full text]
  • Cardiorenal Syndromes Presentation
    Outline Cardiorenal Syndromes: New ° Definitions Insights into Combined Heart and Kidney Failure ° Complex, bidirectional pathogenesis ° Novel diagnostic targets Peter A. McCullough, MD, MPH ° Therapy FACC, FACP, FAHA, FCCP, FNKF ° Putting it all together History Outline •1913: Sir Thomas Lewis gave a clinical lecture on paroxysmal dyspnoea in cardiocardio--renalrenal patients with special reference to “cardiac” and “uremic” asthma •1951: the term cardiorenal syndromes (CRS) was coined by Ledoux [i] •1997 to present: Schrier in multiple papers summarized the impact of salt and ° Definitions water retention combined with neurohormonal activation in the pathogenesis of CRS. [ii] [iii] [iv] ° Complex, bidirectional pathogenesis •2003: Brammah and colleagues pointed out that treatment of bilateral renal arterial disease could result in improvement of both heart and kidney function. [v] •2005: Braam demonstrated in animals that organ dysfunction in one system ° Novel diagnostic targets influences that in the other. [vi] •2008: Ronco and colleagues proposed five distinct CRS according to the temporal sequence of organ injury and failure as well as the clinical context. [vii] ° Therapy •2008: Acute Dialysis Quality Initiative (ADQI) involving nephrology, critical care, cardiac surgery, and cardiology was convened. [viii] ° Putting it all together •2011: Karger launches “Cardiorenal Medicine” James Sowers, MD, Editor •2012: ADQI conducted a second consensus conference to review the spectrum of pathophysiologic mechanisms involved in CRS [i] University College Hospital, London, November 12th, 1913. BMJ 2: 1417–1420. Ledoux P. [Cardiorenal syndrome]. Avenir Med. 1951 Oct;48(8):149-53. [ii] Blair JE, Manuchehry A, Chana A, Rossi J, Schrier RW, Burnett JC, Gheorghiade M. Prognostic markers in heart failure-congestion, neurohormones, and the cardiorenal syndrome.
    [Show full text]
  • Clinically Significant High-Grade AV Block As a Reversible Cause For
    Journal of Clinical Medicine Article Clinically Significant High-Grade AV Block as a Reversible Cause for Acute Kidney Injury in Hospitalized Patients—A Propensity Score Matched Cohort Aviram Hochstadt 1,* , Ido Avivi 2, Merav Ingbir 2, Yacov Shacham 1, Ilan Merdler 1, Yoav Granot 1, Sami Viskin 1, Raphael Rosso 1, Shmuel Banai 1 and Maayan Konigstein 1 1 Division of Cardiology, Tel-Aviv Sourasky Medical Center and the Sackler School of Medicine of The Tel Aviv University, Weizman 6 St., Tel Aviv 64239, Israel; [email protected] (Y.S.); [email protected] (I.M.); [email protected] (Y.G.); [email protected] (S.V.); [email protected] (R.R.); [email protected] (S.B.); [email protected] (M.K.) 2 Internal Medicine J, Tel-Aviv Sourasky Medical Center and the Sackler School of Medicine of The Tel Aviv University, Weizman 6 St., Tel Aviv 64239, Israel; [email protected] (I.A.); [email protected] (M.I.) * Correspondence: [email protected]; Tel.: +972-3-697-4250 Abstract: Background. High-grade AV block (HGAVB) is a life-threatening condition. Acute kidney injury (AKI) which is usually caused by renal hypo-perfusion is associated with adverse outcomes. We aimed to investigate the association between AKI and HGAVB. Methods. This is a retrospective cohort comparing the incidence of AKI among patients with HGAVB requiring pacemaker implan- tation compared with propensity score matched controls. Primary outcome was the incidence of AKI at admission. Secondary outcomes were change in creatinine levels, AKI during stay, recov- Citation: Hochstadt, A.; Avivi, I.; ery from AKI, mortality and major adverse kidney events (MAKE).
    [Show full text]
  • Cardiorenal Syndrome Dr Matt Hall Consultant Renal Physician
    Cardiorenal syndrome Dr Matt Hall Consultant Renal Physician Tuesday, 26 November 2019 • A 72 year old with ischaemic cardiomyopathy is admitted with breathlessness and oedema. • DH: Ramipril 5mg od, Bisoprolol 5mg od, Furosemide 80mg od, Spironolactone 25mg od. • Blood pressure is 115/68 and weight has increased from 95 to 103kg in 3 weeks. • Furosemide was increased to 80mg bd. Bloods checked in a week. • Results: Na 130 K 6.0, Creat 310 (from baseline 135µmol/l), urea 32.5 26/11/2019 Overview • Cardiorenal syndromes • The role of the kidney in heart failure • Medical management: friend or foe? • Strategies • The role of renal replacement therapies in heart failure 26/11/2019 1. What are “cardio-renal syndromes”? 26/11/2019 Cardiorenal syndromes “A syndrome in which acute or chronic dysfunction of the renal or cardiac system induces acute or chronic dysfunction in the other” 26/11/2019 26/11/2019 Cardiorenal syndromes Type Initial event Secondary dysfunction Type 1 Acute heart dysfunction Acute kidney injury (eg, cardiogenic shock) Type 2 Chronic heart dysfunction Progressive renal ischaemia and fibrosis (eg, valvular heart disease) Type 3 Acute kidney failure Fluid overload, dysrhythmia (eg, Goodpasture syndrome) Type 4 CKD Cardiac hypertrophy, fibrosis and (eg, diabetic nephropathy) dysrhythmia Type 5 Multi-organ failure (eg, septic shock) 26/11/2019 2. The kidney is involved in the body’s response to heart failure 26/11/2019 High output Low output failure failure Arterial Increased venous underfilling pressure Carotid Juxtaglomerular Atrial and baroceptors apparatus ventricular stretch Sympathetic Renin activation secretion ↑ANP ↑ BNP ↑Vasopressin ↑Ang II ↑Aldosterone H O Na+ and H O 2 Vasoconstriction 2 retention retention 26/11/2019 High Low output output failure failure Arterial Increased venous underfilling pressure Carotid Juxtaglomerular Atrial and baroceptors apparatus ventricular stretch Sympathetic Renin activation secretion ↑ANP ↑ BNP ↑Vasopressin ↑Ang II ↑Aldosterone H O Na+ and H O 2 Vasoconstriction 2 retention retention 26/11/2019 2.
    [Show full text]
  • Type 4 Cardiorenal Syndrome: Myocardial Dysfunction, Fibrosis, and Heart Failure in Patients with Chronic Kidney Disease Timothy Larsen1, Karthiek Narala2 and Peter A
    & Experim l e ca n i t in a l l C C Larsen et al., J Clinic Experiment Cardiol 2012, 3:4 f a Journal of Clinical & Experimental o r d l DOI: 10.4172/2155-9880.1000186 i a o n l o r g u y o J Cardiology ISSN: 2155-9880 Review Article Open Access Type 4 Cardiorenal Syndrome: Myocardial Dysfunction, Fibrosis, and Heart Failure in Patients with Chronic Kidney Disease Timothy Larsen1, Karthiek Narala2 and Peter A. McCullough3* 1Providence Hospital and Medical Centers, Southfield, USA 2St. John Hospital and Medical Center, Detroit, USA 3St. John Providence Health System, Warren, MI, USA Abstract Chronic kidney disease manifested by a reduction in glomerular filtration function, albuminuria, or markers of chronic renal injury have been consistently associated with the development of heart failure, heart failure hospitalizations, and cardiac mortality. The principal mechanisms by which the cardiac ventricles ultimately fail include pressure overload, volume overload, and cardiomyopathy. Chronic and acute kidney diseases contribute via these pathways to cardiomyopathic processes that can be visualized as adverse remodeling, systolic and diastolic dysfunction, and now with modern imaging and molecular techniques, myocardial fibrosis. It appears that both within the myocardium and the renal parenchyma, as there is loss of functional tissue, there is the deposition of collagen and other proteins resulting in fibrosis. Once this form of repair is initiated, it appears that it is progressively pathogenic itself leading to worsened cardiorenal syndrome type 4, a viscous cycle initiated by kidney disease and leading to heart failure hospitalizations and death. This paper will explore the complicated pathophysiologic processes involved in this syndrome with the aim of elucidating potential future diagnostic and therapeutic targets.
    [Show full text]