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URN Biweekly 2 > Cardiorenal and Hepatorenal syndromes- Bessette > Flashcards

Cardiorenal and Hepatorenal syndromes- Bessette Flashcards

1
Q

A pathophysiologic disorder of the heart and kidneys whereby acute or chronic dysfunction of one organ may induce acute or chronic dysfunction of the other

A

cardiorenal syndrome

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2
Q

acute heart failure + rise in [creatinine] of at least 0.3-0.5 mg/dl

A

acute cardiorenal syndrome

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3
Q

persisting changes in renal function that intensify w/ advancing stages of heart failure

A

chronic cardiorenal syndrome

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4
Q

cardiorenal syndrome type 5 results from what

A

systemic diseases

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5
Q

prerenal hypoperfusion of kidney due to heart failure can lead to

A

cardiorenal syndrome

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6
Q

increased systemic venous congestion can lead to this

A

cardiorenal syndrome

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7
Q

renal arterial hypoperfusion can lead this

A

cardiorenal syndrome

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8
Q

decreased renal perfusion mechanisms that can lead to cardiorenal syndrome

A

SNS activation
ADH released
RAAS
endothelin-1

(vasoconstriction and Na+ and water retention)

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9
Q

what senses low Na+ and low renal blood flow at the level of kidney

A

JG apparatus

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10
Q

decrease in CO and SV lead to hypoperfusion of kidneys and increases RAAS

A

acute cardiorenal syndrome

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11
Q

Escape from salt and water retaining effects of aldosterone by increasing sodium excretion (that lead to acute cardiorenal syndrome)

A

aldosterone escape

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12
Q

ANP and BNP released to volume expansion of heart and further lead to what

A

decrease in kidneys ability to absorb Na+ and then acute cardiorenal syndrome

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13
Q

Pathological changes of acute syndrome that progress more slowly and in parallel to deterioration of cardiac function

A

chronic cardiorenal syndrome

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14
Q

**Ominous prognostic sign in Class IV HF

A

hyponatremia (constant release of ADH)

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15
Q

reduced distal Na+ delivery and flow impair K+ secretion in collecting tubule

A

hyperkalemia

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16
Q

cardinal manifestations of chronic cardiorenal syndrome

A

hyponatremia
hyperkalemia

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17
Q

Serum:
Creatinine elevated
Na+ low
K+ high

A

chronic cardiorenal syndrome

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18
Q

Urine:
Na+ level in chronic cardiorenal syndrome

A

low (due to compensatory mechanisms in heart failure—which is the last thing they need—more edema)

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19
Q

urine K+ level in chronic cardiorenal syndrome

A

low

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20
Q

urine osmolality in cardiorenal syndrome

A

high (water and Na+ being reabsorbed for compensatory mechanism)

21
Q

dyspnea walking to bathroom; edema to level of knees
what class of CRS

A

class IV

22
Q

in cardiorenal syndrome, GFR is supported by what

A

Ang II dependency (efferent arteriole constriction)

23
Q

______ are used to prevent volume overload, but can cause further increase in RAAS if overuse them

A

diuretics

24
Q

____used to treat heart failure, but cause efferent arteriole dilation and decrease in GFR

A

ACEIs/ARBs

25
Q

Treatment of choice for cardiorenal syndrome until CO and ECF volume at steady state at which time ACEI/ARB started

A

hydralazine + nitrate

26
Q

drug used for cardiorenal syndrome that reduces afterload

A

Hydralazine

27
Q

drug used for cardiorenal syndrome that reduces preload

A

nitrate

28
Q

Most common cause of reduced GFR in cirrhosis

A

renal hypoperfusion

29
Q

3 main causes of AKI in liver disease

A

renal hypoperfusion
arterial underfilling
hypovolemia

30
Q

a reversible condition that is a predecessor to hepatorenal syndrome

A

AKI

31
Q

2nd most common cause of reduced GFR in cirrhosis

A

acute tubular necrosis

32
Q

most often associated with sepsis (bacterial peritonitis, bacteremia) and/or prolonged pre-renal state

A

acute tubular necrosis

33
Q
A

ATN

34
Q
A

ATN

35
Q

the liver is the problem in this syndrome

A

hepatorenal syndrome (HRS)

36
Q

is a potentially reversible functional renal impairment that occurs in patients with advanced liver cirrhosis or those with fulminant hepatic failure. The kidneys are responding appropriately

A

hepatorenal syndrome

37
Q

diagnosis of exclusion (ruling out all other causes of AKI)

A

hepatorenal syndrome

38
Q

4 main causes of cirrhosis

A

Chronic Hep C
Chronic Hep B
alcoholic liver disease
nonalcoholic liver disease

39
Q

1 cause of cirrhosis in the US

A

chronic hep C

40
Q

at least 40% of people w/_____ and ______ will develop hepatorenal syndrome

A

cirrhosis and ascites

41
Q

pathophys of HRS

A

splanchnic vasodilation
peripheral vasodilation
renal vasoconstriction

42
Q
A

HRS renal vasoconstriction (to compensate)

43
Q

rapid progression
high mortality
rarely live longer than 3 months

A

HRS-AKI

44
Q

no precipitating factor
refractory ascites
poor prognosis

A

HRS-NAKI

45
Q

this type of HRS has the worst prognosis

A

HRS-AKI

46
Q

Tx aimed at increasing effective arterial volume

A

HRS-AKI

47
Q

splanchnic vasoconstrictor used in HRS-AKI

A

octreotide

48
Q

systemic vasoconstrictor used in HRS AKI

A

midodrine
NE

49
Q

don’t put patient on _____ unless they have improving liver function or candidate for liver transplant

A

dialysis

URN Biweekly 2 (15 decks)

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