Cardiorenal syndrome. Pouchelon. 2015. JSAP Flashcards
What is type 1 CRS?
type 1, involving acute worsening of heart function leading to kidney injury, such as that occurring in patients with acute congestive heart failure (CHF)
What is type 2 CRS?
type 2, involving chronic disease of the heart leading to kidney injury, such as that occurring in patients with chronic heart failure
What is type 3 CRS?
type 3, involving acute worsening of kidney function leading to heart injury, such as that in patients with acute kidney injury (AKI)
What is type 4 CRS?
type 4, involving chronic kidney disease (CKD) leading to heart injury
What is type 5 CRS?
type 5, involving systemic disease(s) leading to simultaneous injury of both the heart and kidney, such as that occurring in patients with sepsis, systemic hypertension or amyloidosis
How does the CRS consesus group call CRS?
Cardiovascular Renal Disorder –> to include the vasculature as well
What are the most common cardiac diseases in dogs?
- valvular disease
- DCM
- heartworm disease
What are the most common cardiac diseases in cats?
- HCM
- other myopathies
- systemic hypertension
What are the most common renal diseases in dogs?
- glomerular disease
- pyelonephritis
- acute tubular necrosis
- tubulointerstitial disease
What are the most common renal diseases in cats?
- idiopathic chronic end-stage kidney disease with tubulointerstitial fibrosis
What does CvRDH refer to?
CvRDH refers to kidney injury or dysfunction emanating from a primary disease process involving the cardiovascular system.
What are potential mechanisms by which CvRDH causes kidney damage?
- decreased kidney perfusion secondary to decreased cardiac output, hypotension, or cardiac shock
- activation of neuroendocrine systems, namely RAAS and SNS
- abnormal or injured endothelial tissue –> reactive oxygen species
- congestion of the kidney
- systemic arterial thromboembolism –> renal infarction
- systemic hypertension –> glomerular disease
describe how CvRDH affects the hydrostatic glomerular filtration gradient and kidney function
the hydrostatic glomerular filtration gradient is defined as the difference between the glomerular blood pressure and the capsular hydrostatic pressure = influenced by the systemic venous pressure
elevated systemic venous pressure + poor cardiac function –> renal congestion –>
- increases capsular hydrostatic pressure
- decreases glomerular filtration pressure
–> decreases GFR –> decreases kidney function
How does Furosemide potentially damage the kidneys?
- volume contraction –> worsening kidney function
- stimulation of the RAAS system
- increases amount of Na reaching the distal tubule –> increases adenosin secretion –> vasoactive mechanisms –> decreases renal function –> contributes to diuretic resistance
which 2 factors do in combination predict poor renal tolerance of acute diuresis?
(1) non-dilated left and right ventricles with a steep pressure-volume relationship (e.g. de novo acute heart failure, diastolic heart failure) and
(2) no or minimal peripheral edema
What does CVRDK refer to?
CvRDK refers to cardiovascular injury or dysfunction emanating from a primary disease process involving the kidney
describe how CvRDK affects the cardiovascular system
- drugs used for cardiac disease (e.g., digoxin, enalapril and atenolol) undergo renal excretion and cause primary kidney dysfunction, with reduced drug clearance –> toxicity –> arrhythmias, hypotension and worsening myocardial function
- Fluid volume and haemodynamic status are virtually always abnormal in patients with severe kidney disease
- Kidney injury can also lead to systemic volume overload that contributes to congestion
- SHT is a common sequela to CKD and can result in myocardial hypertrophy and dysfunction
- azotaemia itself may have adverse effects on cardiac myocytes
What does CvRDO refer to?
CvRDO refers to kidney and cardiovascular injury or dysfunction emanating from either a primary disease process outside the two systems or instances in which primary kidney and cardiovascular diseases coexist
e. g., sepsis, infectious disease
e. g., primary glomerular disease and myxomatous mitral valve degeneration
What systolic blood pressure indicates progressive risk of end- or target-organ damage
systolic pressure > 160 mm Hg
How does SHT affect the kidneys
can result in:
- increased rate of renal injury
- proteinuria
- decreased GFR
- increased incidence of uraemic crisis
How does hypotension affect the kidneys?
- reduces tissue perfusion and GFR
- activates maladaptive neurohormonal response
name 2 examples of diuretics
- furosemide
- hydrochlorthiazide
name 6 examples for vasodilators
- ACEI
- amlodipine
- diltiazem
- nitroglycerin
- hydralazine
- nitroprusside
how does renal function affect furosemide efficacy?
furosemide requires active secretion across proximal renal tubular cells in order to reach the lumen and its site of co-transporter binding, so that decreased renal perfusion or tubular injury decreases the expected diuretic response
