Acute Kidney Injury in Heart Failure Revisited—The Ameliorating Impact of “Decongestive Diuresis” on Renal Dysfunction in Type 1 Acute Cardiorenal Syndrome: Accelerated Rising Pro B Naturetic Peptide Is a Predictor of Good Renal Prognosis

Abstract

There is mounting evidence that forward heart failure as manifested by low cardiac output alone does not define the degree of renal dysfunction in cardiorenal syndrome. As a result, the term “congestive renal failure” was coined in 2012 by Ross to depict the role of renal venous hypertension in type 1 acute cardiorenal syndrome. If so, aggressive decongestive therapies, either through mechanical ultrafiltration with dialysis machines or pharmacologic ultrafiltration with potent diuretics, would lead to improved cardio and renal outcomes. Nevertheless, as recently as 2012, a review of this literature had concluded that a renal venous hypertension-directed approach using diuretics to manage cardio-renal syndrome was yet to be fully investigated. We, in this review, with three consecutive case series, describe our experience with pharmacologic decongestive diuresis in this paradigm of care and argue for studies of such therapeutic interventions in the management of cardiorenal syndrome. Finally, based on our observations in the Renal Unit, Mayo Clinic Health System, in Northwestern Wisconsin, we have hypothesized that patients with cardiorenal syndrome presenting with accelerated rising Pro B Naturetic Peptide levels appear to represent a group that would have good cardio- and renal-outcomes with such decongestive pharmacologic therapies.

Agravamento da Função Renal e Congestão em Pacientes com Insuficiência Cardíaca Aguda: Estudo com Análise Vetorial de Bioimpedância Elétrica (BIVA) e Lipocalina Associada à Gelatinase Neutrofílica (NGAL)

“…13,17 Com base nesses achados, a terapia agressiva da congestão tem sido proposta como o principal tratamento do AFR na ICAD. [18][19][20] Em um estudo, 18 um protocolo com intensificação do tratamento com diuréticos em pacientes com AFR e ICAD resultou em maior alteração de peso e maior perda líquida de fluidos após 24 horas em comparação ao tratamento padrão, com uma leve melhor na função renal. 18 Não encontramos relação entre NGAL na admissão e AFR, ou entre NGAL na alta e desfechos.…”

Alteration in Renal Function Following Loop Diuretics in Patients With Acute Decompensated Heart Failure

“…Among the patients with renal dysfunction, 76% improved at the time of discharge. It depicts that the progress of the condition was owing to the control of the disease [12]. The magnitude of dose variation among individuals was dependent on the clinical condition of the patients.…”

SIRT1 gene polymorphisms are associated with nondiabetic type 1 cardiorenal syndrome

“…Low cardiac output alone, resulting from heart failure, does not define the degree of renal dysfunction in CRS. As a result, the term "congestive renal failure" was proposed to reflect the role of renal venous hypertension in CRS1 (Di Nicolo, 2018;Onuigbo, Agbasi, Sengodan, & Rosario, 2017). In addition to hemodynamic alterations, inflammatory activity and neurohormonal activation also contribute to worsened kidney function in AHF (Palazzuoli, McCullough, Ronco, & Nuti, 2015;Virzi et al, 2015).…”