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Lung-Kidney Cross-Talk

Objectives This chapter will: 1. Review the pathophysiology of acute lung injury. 2. Summarize the emerging understanding of lung-kidney cross-talk in the critically ill patient. 3. Identify the mechanisms by which acute kidney injury may potentiate acute lung injury. Growing evidence points to harmful interactions between lung and kidney dysfunctions, which suggests a partial explanation for the natural history of multiorgan failure. This is important because…

Recent Advances for Stroke Prevention in Patients With Atrial Fibrillation and Advanced Kidney Disease

Objectives This chapter will: 1. Describe the efficacy/safety of oral anticoagulant therapy in chronic kidney disease patients with atrial fibrillation. 2. Identify novel oral anticoagulants in chronic kidney disease patients with atrial fibrillation. 3. Discuss percutaneous left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation, with and without chronic kidney disease. Atrial fibrillation (AF) is the most common cardiac arrhythmia in the general…

Management of Overhydration in Heart Failure Patients

Objectives This chapter will: 1. Describe the current treatment options for decongestion in acute decompensated heart failure. 2. Review key clinical trials of ultrafiltration in heart failure management. 3. Describe clinical goals and targets of obtaining adequate decongestion. It is estimated that more than one million patients are hospitalized annually with the primary diagnosis of acute decompensated heart failure (ADHF). More than 70% of these patients…

Principles of Diuretic Management in Heart Failure

Objectives This chapter will: 1. Explain the negative effects of extra cellular fluid volume expansion on cardiac and renal function. 2. Explain how heart failure and chronic kidney disease contribute to diuretic resistance. 3. Identify risk factors for worsening renal function in acute decompensated heart failure. 4. Describe combination diuretic therapy in acute decompensated heart failure. Heart failure (HF) currently affects approximately 26 million adults worldwide,…

The Kidney in Diastolic Dysfunction

Objectives This chapter will: 1. Review the pathophysiology of diastolic dysfunction and the complex interaction between the heart and the kidney in the context of cardiorenal syndromes (disorders of the heart and kidneys in which acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other). 2. Explain the role of congestive kidney failure (venous congestion or backward failure) as a…

Renal Function During Cardiac Mechanical Support and Artificial Heart

Objectives This chapter will: 1. Introduce the types of mechanical cardiac support. 2. Evaluate the clinical evidence regarding the impact of mechanical cardiac devices on renal function in patients with severe congestive heart failure. 3. Examine renal and patient outcomes in recipients of mechanical heart devices. Heart failure (HF) remains one of the leading causes of hospitalization and is associated with significant morbidity and mortality. According…

Cardiorenal Syndrome Type 5

Objectives The chapter will: 1. Describe epidemiology, pathophysiology, diagnosis, and main clinical features of cardiorenal syndrome type 5 (CRS-5). 2. Review main clinical disease leading to CRS-5 development. 3. Identify widespread treatment guidelines in CRS-5 patients. The cardiorenal syndromes (CRS) recently have been defined systematically as disorders of heart or kidney whereby one organ dysfunction leads to dysfunction of another. Five types of CRS are defined.…

Cardiorenal Syndrome Type 4

Objectives This chapter will: 1. Review conventional and nonconventional cardiovascular risk factors related to chronic kidney disease. 2. Explain how to assess and manage cardiovascular risk in chronic kidney disease. Definition and Epidemiology Cardiorenal syndrome (CRS) type 4, or chronic renocardiac syndrome, is characterized by chronic abnormalities in renal function, such as chronic glomerular disease and autosomal dominant polycystic kidney disease, leading to decreased cardiac function,…

Cardiorenal Syndrome Type 3

Objectives This chapter will: 1. Identify mechanisms of cardiac dysfunction during acute kidney injury. 2. Understand issues applying data from animal models to human kidney injury events. 3. Appreciate short-term mortality and long-term increase in cardiovascular events associated with kidney failure episodes. Cardiorenal syndrome type 3 (CRS-3) refers to the impact of acute kidney injury (AKI) on cardiac function. AKI is very common among hospitalized patients…

Cardiorenal Syndrome Type 2

Objectives This chapter will: 1. Review the definition and epidemiology of cardiorenal syndrome type 2 (CRS-2). 2. Identify the theoretical pathogenic pathways of CRS-2. 3. Discuss management strategies for CRS-2. 4. Introduce adjunct management assistive devices, such as cardiac resynchronization therapy and implantable pulmonary artery pressure sensors. Heart failure (HF) is a growing public health problem in the United States, affecting more than 5 million people,…

Cardiorenal Syndrome Type 1

Objectives This chapter will: 1. Describe the pathophysiologic pathways of heart and kidney interaction. 2. Characterize the effect of heart failure on the kidney. 3. Identify risk factors and preexisting comorbid conditions. 4. Describe the clinical outcomes and potential therapeutic interventions. Combined disorders of heart and kidney are classified as cardiorenal syndromes (CRS). According to the new classification, the cross-talk between the heart and the kidney…

Classification of Cardiorenal Syndrome

Objectives The chapter will: 1. Provide an overview of cardiorenal syndrome (CRS) classification. 2. Briefly review cardiorenal syndromes definitions and clinical implications. 3. Focus on main pathophysiologic features of each CRS. Large numbers of hospitalized patients have various degrees of heart and kidney dysfunction ; primary disease of the heart or kidney often involves dysfunction of or injury to the other. Based on this organ cross-talk,…

Heart-Kidney Cross-Talk

Objectives This chapter will: 1. Review the epidemiology and classification system applied to cardiorenal syndromes. 2. Understand the predisposing factors that increase the risk for acute and chronic cardiorenal syndromes. 3. Explore the wide range of systems and mediators involved in organ cross-talk in the setting of critical illness. Combined disorders of heart and kidney are classified as cardiorenal syndromes (CRS) and include a variety of…

Cellular Response to Acute Kidney Injury

Objectives This chapter will: 1. Describe the effects of impaired cytokine clearance during acute kidney injury (AKI). 2. Review experimental and clinical findings of neutrophil dysfunction during AKI. 3. Discuss the role of resistin linking inflammation and uremia during AKI. Despite steady improvement in renal replacement therapy (RRT) and numerous clinical trials to identify the optimal conditions/modes of RRT, the survival rate of (critically ill) patients…

Immunologic and Infectious Complications of Acute Kidney Injury

Objectives This chapter will: 1. Provide an overview of the epidemiology of infection in patients with acute kidney injury. 2. Describe the diverse pathophysiologic mechanisms that may explain increased risk for infection in patients with acute kidney injury. Epidemiology of Infection in Patients With Acute Kidney Injury Infection is among the most important causes of morbidity, hospitalization, costs, and mortality in patients with end-stage renal disease.…

Neurologic Problems in Acute Renal Failure

Objectives This chapter will: 1. Outline the basic pathophysiology of the brain in acute renal failure. 2. Identify the infections known to be associated with the development of acute renal failure and cerebral dysfunction. 3. Describe the role of vascular disease in the pathogenesis of acute renal failure and cerebral dysfunction. 4. Delineate the mechanisms by which electrolyte disorders may cause or potentiate acute renal failure…

Water and Electrolyte Disturbances in Acute Renal Failure

Objectives This chapter will: 1. Describe the common electrolyte disturbances seen in patients with acute renal failure. 2. Review the diagnosis and treatment of hyperkalemia. 3. Review the diagnosis and treatment of hyponatremia and hypernatremia. Water and electrolyte disturbances are among the most common complications of acute renal failure. Imbalances in plasma sodium, potassium, calcium, and phosphate are the most common electrolyte disturbances and require a…

Cardiovascular Problems in Acute Kidney Injury

Objectives This chapter will: 1. Delineate the differences between cardiovascular problems in acute kidney injury and those in chronic kidney disease. 2. Characterize the typical cardiovascular problems occurring in acute kidney injury and their consequences for patient outcome. 3. Review the basic pathophysiologic concepts underlying the development of cardiovascular problems in acute kidney injury. Kidney and heart disease often coexist; the heart is highly dependent on…

Gastrointestinal Problems in Acute Kidney Injury

Objectives This chapter will: 1. Present an overview of the epidemiology, pathogenesis, and clinical features of common gastrointestinal problems associated with acute renal failure. 2. Describe the management of common gastrointestinal problems associated with acute renal failure. The second half of the 20th century saw remarkable changes in the clinical presentation of patients suffering from acute renal failure (ARF). These changes relate to the emergence of…

Bleeding and Hemostasis in Acute Renal Failure

Objectives This chapter will: 1. Review the physiology of primary hemostasis, coagulation, and fibrinolysis. 2. Discuss the pathogenesis of bleeding in uremia and acute renal failure. 3. Examine the causes of venous and arterial thrombosis in uremia and acute renal failure. Physiologic Hemostasis Physiologic hemostasis is the result of a complex series of events that take place to stop bleeding at the site of injury while…