Korean Circ J.  2011 Oct;41(10):565-574. 10.4070/kcj.2011.41.10.565.

Renal Dysfunction in Acute Heart Failure

• Han SW
• Ryu KH

• KMID: 2297914
• DOI: http://doi.org/10.4070/kcj.2011.41.10.565

Abstract

During treatment of acute heart failure (AHF), worsening renal function is often complicated and results in a complex clinical course. Furthermore, renal dysfunction is a strong independent predictor of long-term adverse outcomes in patients with AHF. Traditionally, the predominant cause of renal dysfunction has been attributed to impairment of cardiac output and relative underfilling of arterial perfusion. Recently, emerging data have led to the importance of venous congestion and elevated intra-abdominal pressure rather than confining it to impaired forward cardiac output as the primary driver of renal impairment. Relief of congestion is a major objective of AHF treatment but therapy is still based on the administration of loop diuretics. The results of the recently performed controlled studies for the assessment of new treatments to overcome resistance to diuretic treatment to protect kidneys from untoward effects have been mostly neutral. Better treatment of congestion in heart failure remains a major problem.

Keyword

Acute heart failure; Kidney function; Cardiorenal syndrome

MeSH Terms

Cardiac Output
Cardio-Renal Syndrome
Estrogens, Conjugated (USP)
Heart
Heart Failure
Humans
Hyperemia
Kidney
Perfusion
Sodium Potassium Chloride Symporter Inhibitors
Estrogens, Conjugated (USP)
Sodium Potassium Chloride Symporter Inhibitors

Figure

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  Fig. 1 Pathophysiological mechanisms of worsening renal function in acute heart failure.

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  Fig. 2 Adjusted survival plots grouped by BUN and high dose loop diuretics use.46)

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