Cardiorenal syndrome

(CJASN 2017;12:1624)

Multifactorial pathophys including:

• 1. ↓ CO,
• 2. ↑ renal venous congestion,
• 3. ↑ RAAS

Bidirectionality:

• acute CHF → AKI,
• and oliguric AKI can worsen CHF
• (JACC 2008;52:1527)

Rx

• IV loop diuretics
• (bypass gut edema; dosing below)
• no diff. between high vs. low dose and bolus vs. gtt (NEJM 2011;364:797).
• No clinical benefit: dopa, nesiritide, ultrafilt.

Prognosis:

• 7% ↑ mortality a/w each 10 mL/min ↓ eGFR in ADHF (JACC 2006;47:1987)