CARDIORENAL SYNDROME CRS

Question 1

What is the definition of Cardiorenal Syndrome (CRS)?

Answer 1

Overlap of heart and kidney dysfunction.

Question 2

What are the types of Cardiorenal Syndrome?

Answer 2

• Type 1 (CRS-1)
• Type 2 (CRS-2)
• Type 3 (CRS-3)
• Type 4 (CRS-4)
• Type 5 (CRS-5)

Question 3

What characterizes Type 1 Cardiorenal Syndrome (CRS-1)?

Answer 3

Acute heart failure leading to acute kidney injury (AKI).

Question 4

What are the hemodynamic mechanisms in CRS-1?

Answer 4

• Decreased kidney artery blood flow due to heart failure.
• Cold Patients: Severe vasoconstriction, reduced effective circulating volume.
• Warm Patients: Increased central venous pressure (CVP), pulmonary/systemic congestion.

Question 5

What is the prevalence of CRS-1 in patients with acute decompensated heart failure?

Answer 5

25% of patients.

Question 6

What are the biomarkers used for CRS-1?

Answer 6

• Cystatin C
• NGAL
• Bioimpedance for fluid volume.

Question 7

What diagnostic tools are used for CRS-1?

Answer 7

• Echocardiography
• Kidney Ultrasound

Question 8

What treatments are typically used for CRS-1?

Answer 8

• Diuretics
• Beta-blockers
• ACE inhibitors
• ARBs
• Inotropic support for cardiogenic shock.

Question 9

What characterizes Type 2 Cardiorenal Syndrome (CRS-2)?

Answer 9

Chronic heart failure leading to chronic kidney disease (CKD).

Question 10

What are the mechanisms involved in CRS-2?

Answer 10

• Neurohormonal activation
• Kidney hypoperfusion
• Venous congestion
• Inflammation
• Oxidative stress.

Question 11

What diagnostic tools are used for CRS-2?

Answer 11

• Kidney Ultrasound
• Echocardiography

Question 12

What management strategies are used for CRS-2?

Answer 12

• Pharmacological: Diuretics, RAAS blockade, careful monitoring of kidney function.
• Ultrafiltration for fluid overload when diuretics fail.

Question 13

What characterizes Type 3 Cardiorenal Syndrome (CRS-3)?

Answer 13

Acute kidney injury leading to heart dysfunction.

Question 14

What are the mechanisms involved in CRS-3?

Answer 14

• Immune modulation
• RAAS activation
• Sympathetic nervous system hyperactivity.

Question 15

What is the epidemiology of CRS-3?

Answer 15

70% of ICU patients develop AKI, with high mortality rates.

Question 16

What diagnostic tools are used for CRS-3?

Answer 16

• Kidney Ultrasound
• Echocardiography

Question 17

What are the management stages in CRS-3?

Answer 17

• Stage 1 (Risk): Avoid nephrotoxic drugs, monitor kidney function.
• Stage 2 (Injury): Hemodynamic monitoring, electrolyte management.
• Stage 3 (Failure): Renal replacement therapy (RRT) if needed.

Question 18

What characterizes Type 4 Cardiorenal Syndrome (CRS-4)?

Answer 18

Chronic kidney disease leading to cardiovascular disease.

Question 19

What are the mechanisms involved in CRS-4?

Answer 19

• Hypertension
• Volume overload
• Hyperphosphatemia
• Chronic inflammation.

Question 20

What is the epidemiology of CRS-4?

Answer 20

Increased cardiovascular risk with declining eGFR.

Question 21

What diagnostic tools are used for CRS-4?

Answer 21

• Echocardiography
• Kidney Ultrasound

Question 22

What management strategies are used for CRS-4?

Answer 22

• Pharmacological: ACE inhibitors, ARBs, beta-blockers, phosphate binders.
• Lifestyle: Control of hypertension, dyslipidemia, and volume overload.

Question 23

What characterizes Type 5 Cardiorenal Syndrome (CRS-5)?

Answer 23

Systemic disease leading to simultaneous heart and kidney dysfunction.

Question 24

What are the mechanisms involved in CRS-5?

Answer 24

• Inflammation
• Immune dysregulation
• Autonomic dysfunction.

Question 25

What biomarkers are associated with CRS-5?

Answer 25

* Lipopolysaccharide binding protein * Procalcitonin * CRP * IL-6.

Question 26

What management strategies are used for CRS-5?

Answer 26

* Hemodynamic Stability: Fluid therapy, vasopressors, inotropes. * Renal Support: Avoid nephrotoxins, early RRT if indicated.

Question 27

True or False: Cystatin C is a better predictor of long-term outcomes in ADHF than serum creatinine.

Answer 27

True.

Question 28

What is a common issue in CRS-2 that may require alternative strategies?

Answer 28

Diuretic resistance.

Question 29

What is the high mortality rate associated with CRS-3 primarily due to?

Answer 29

AKI leading to acute heart dysfunction.

Question 30

What cardiovascular risk increases with declining eGFR in CRS-4?

Answer 30

Increased cardiovascular risk.

Question 31

Fill in the blank: CRS-5 involves simultaneous heart and kidney dysfunction due to _______.

Answer 31

[systemic diseases like sepsis].