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Patients with heart failure often present with impaired renal function which

Patients with heart failure often present with impaired renal function which is a predictor of poor outcome. are often associated with resistance and limited APY29 clinical success. That leads to an increasing concern about novel options such as the use of vasopressin antagonists adenosine A1 receptor antagonists and renal-protective dopamine. Initial clinical trials have shown quite encouraging results in some heart failure subpopulations but have failed to demonstrate a clear beneficial role of these agents. On the other hand ultrafiltration appears to be a more promising therapeutic procedure that will improve volume regulation while preserving renal and cardiac function. Further clinical studies are required in order to determine their net effect on renal function and potential cardiovascular outcomes. Until then management of the cardiorenal syndrome remains quite empirical. 1 Introduction Renal dysfunction is one of the most important comorbidities in heart failure. Decreased estimated glomerular filtration rate (GFR) seems to be a potent predictor of cardiovascular complications and mortality [1]. In addition worsening heart failure or acute decompensated heart failure (ADHF) can accelerate worsening of renal function that is what we call cardiorenal syndrome (CRS). The most common underlying risk factors that account for renal dysfunction in the establishing of heart failure or cardiac dysfunction include hypertension diabetes mellitus severe atherosclerotic disease seniors age and a prior history of renal insufficiency or heart failure [2]. As individuals with heart failure Rabbit polyclonal to ORC5L. are surviving much longer and dying less frequently from main arrhythmia we suppose that the CRS will become more common in the near future. However there is no a single definition that appropriately explains this entity. It is well approved that cardiovascular morbidity and mortality and diminished renal function are closely correlated. This relationship is present regardless of whether the initial event is definitely a parenchymal disease of the kidney or a cardiac disease. APY29 In SOLVD (Studies of Remaining Ventricular Dysfunction) trial individuals having a GFR less than 60?ml/minute/1.73?m2 had a 40% higher risk of death [3 4 In addition in the ADHERE (Acute Decompensated Heart Failure National Registry) populace mortality risk for the hospitalized individuals could be estimated using three variables: systolic blood pressure blood urea nitrogen (BUN) and serum creatinine levels. Two of the above three most important predictors of in-hospital survival are related to kidney function [5]. Similarly Gottlieb et al. showed that in hospitalized individuals worsening renal function predicts a prolonged hospitalization or an increased risk of death [6]. The current proposed definition divides CRS into five subtypes: type I acute CRS (20-25%) which displays an abrupt worsening of cardiac function (e.g. acute cardiogenic shock or acutely decompensated congestive heart failure) leading to acute kidney injury; type II chronic CRS (30-45%) in which chronic abnormalities in cardiac function (e.g. chronic congestive heart failure) cause progressive and potentially long term chronic kidney disease; type III acute renocardiac syndrome (30-35%) which displays an abrupt worsening of renal function (e.g. acute kidney ischaemia or glomerulonephritis) leading to acute cardiac disorder (e.g. heart failure arrhythmia or ischemia); type IV chronic renocardiac syndrome (45-50%) in which chronic kidney disease (e.g. chronic glomerular or interstitial disease) contributes to decreased cardiac function cardiac hypertrophy and/or improved risk of adverse cardiovascular events; and type V secondary CRS meaning systemic diseases such as diabetes mellitus sepsis and amyloidosis that deteriorate simultaneously cardiac and renal function [7 8 2 Pathophysiology of the CRS Heart and kidney overall performance are closely APY29 interrelated physiologically and pathophysiologically both in health and in disease. Although there is a growing recognition of the frequent presentation of the CRS its underlying pathophysiology is not yet well recognized and no consensus concerning its appropriate management has been accomplished. A APY29 decreased cardiac output in CHF resulting in reduced renal perfusion could be an easy explanation for the worsening renal function. But worsening renal function has also been shown among individuals with ADHF with maintained remaining ventricular ejection portion. This deterioration in renal overall performance despite a presumed preservation of blood flow to the kidneys offers led.