Cardiorenal and Hepatorenal syndromes- Bessette Flashcards
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
cardiorenal syndrome
acute heart failure + rise in [creatinine] of at least 0.3-0.5 mg/dl
acute cardiorenal syndrome
persisting changes in renal function that intensify w/ advancing stages of heart failure
chronic cardiorenal syndrome
cardiorenal syndrome type 5 results from what
systemic diseases
prerenal hypoperfusion of kidney due to heart failure can lead to
cardiorenal syndrome
increased systemic venous congestion can lead to this
cardiorenal syndrome
renal arterial hypoperfusion can lead this
cardiorenal syndrome
decreased renal perfusion mechanisms that can lead to cardiorenal syndrome
SNS activation
ADH released
RAAS
endothelin-1
(vasoconstriction and Na+ and water retention)
what senses low Na+ and low renal blood flow at the level of kidney
JG apparatus
decrease in CO and SV lead to hypoperfusion of kidneys and increases RAAS
acute cardiorenal syndrome
Escape from salt and water retaining effects of aldosterone by increasing sodium excretion (that lead to acute cardiorenal syndrome)
aldosterone escape
ANP and BNP released to volume expansion of heart and further lead to what
decrease in kidneys ability to absorb Na+ and then acute cardiorenal syndrome
Pathological changes of acute syndrome that progress more slowly and in parallel to deterioration of cardiac function
chronic cardiorenal syndrome
**Ominous prognostic sign in Class IV HF
hyponatremia (constant release of ADH)
reduced distal Na+ delivery and flow impair K+ secretion in collecting tubule
hyperkalemia
cardinal manifestations of chronic cardiorenal syndrome
hyponatremia
hyperkalemia
Serum:
Creatinine elevated
Na+ low
K+ high
chronic cardiorenal syndrome
Urine:
Na+ level in chronic cardiorenal syndrome
low (due to compensatory mechanisms in heart failure—which is the last thing they need—more edema)
urine K+ level in chronic cardiorenal syndrome
low
urine osmolality in cardiorenal syndrome
high (water and Na+ being reabsorbed for compensatory mechanism)
dyspnea walking to bathroom; edema to level of knees
what class of CRS
class IV
in cardiorenal syndrome, GFR is supported by what
Ang II dependency (efferent arteriole constriction)
______ are used to prevent volume overload, but can cause further increase in RAAS if overuse them
diuretics
____used to treat heart failure, but cause efferent arteriole dilation and decrease in GFR
ACEIs/ARBs
