Moffitt AM Report 1/24/17: Cardiorenal Syndrome

Today we discussed the case of a middle-aged man with history of HFrEF, severe AS, afib, and substance use disorder who presented with decompensated heart failure, with eventual progression to cardiogenic shock, oliguric renal failure, and symptomatic bradycardia. We had several interesting discussions on etiology/management of symptomatic bradycardia, approach to AKI in decompensated heart failure, as well as management of a patient with cardiogenic shock. See below for more details on “Cardiorenal Syndrome.”

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 Cardiorenal Syndrome

  • There are 5 different “types” of cardiorenal syndrome.
  • What is it? Simply put, cardiorenal syndrome (CRS) is an umbrella term used to define disorders of heart and kidneys where acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other (heart à kidney or kidney à heart)
Type Inciting Event Secondary Disturbance Example
Type 1 (acute CRS) Acute decline in heart function Kidney injury Acute cardiogenic shock or acute decompensation of chronic heart failure
Type 2 (chronic CRS) Chronic abnormalities in heart function Progressive CKD Chronic heart failure
Type 3 (acute renocardiac syndrome) Abrupt worsening of kidney function Acute cardiac disorder AKI or glomerulonephritis
Type 4 (chronic renocardiac syndrome) Chronic Kidney Disease Decreased cardiac function, hypertrophy, increased risk of coronary disease, arrhythmia Chronic glomerular disease
Type 5 (secondary CRS) Systemic condition Both heart and kidney dysfunction DM, sepsis, autoimmune

 

  • In patients with heart failure who have an elevated serum creatinine and/or reduced eGFR, it is important to distinguish between underlying kidney disease versus impaired kidney function due to CRS
    • Findings suggestive of underlying kidney disease: significant proteinuria (usually more than 1 g/day), active urine sediment with hematuria, small kidneys on radiologic evaluation
  • Pathophysiology of Type I &II CRS:

cardiorenal

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