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J. Clin. Med. 2017, 6(9), 82; doi:10.3390/jcm6090082

Acute Kidney Injury in Heart Failure Revisited—The Ameliorating Impact of “Decongestive Diuresis” on Renal Dysfunction in Type 1 Acute Cardiorenal Syndrome: Accelerated Rising Pro B Naturetic Peptide Is a Predictor of Good Renal Prognosis

1
College of Medicine, Mayo Clinic, Rochester, MN 55905, USA
2
Department of Nephrology, Mayo Clinic Health System, Eau Claire, WI 54702, USA
3
North East London NHS Foundation Trust, Ilford, Essex 1G3 8XJ, UK
4
Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54702, USA
5
Medical School, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA
*
Author to whom correspondence should be addressed.
Academic Editor: Lindsay Brown
Received: 7 July 2017 / Revised: 16 August 2017 / Accepted: 23 August 2017 / Published: 29 August 2017
View Full-Text   |   Download PDF [4025 KB, uploaded 29 August 2017]   |  

Abstract

There is mounting evidence that forward heart failure as manifested by low cardiac output alone does not define the degree of renal dysfunction in cardiorenal syndrome. As a result, the term “congestive renal failure” was coined in 2012 by Ross to depict the role of renal venous hypertension in type 1 acute cardiorenal syndrome. If so, aggressive decongestive therapies, either through mechanical ultrafiltration with dialysis machines or pharmacologic ultrafiltration with potent diuretics, would lead to improved cardio and renal outcomes. Nevertheless, as recently as 2012, a review of this literature had concluded that a renal venous hypertension-directed approach using diuretics to manage cardio-renal syndrome was yet to be fully investigated. We, in this review, with three consecutive case series, describe our experience with pharmacologic decongestive diuresis in this paradigm of care and argue for studies of such therapeutic interventions in the management of cardiorenal syndrome. Finally, based on our observations in the Renal Unit, Mayo Clinic Health System, in Northwestern Wisconsin, we have hypothesized that patients with cardiorenal syndrome presenting with accelerated rising Pro B Naturetic Peptide levels appear to represent a group that would have good cardio- and renal-outcomes with such decongestive pharmacologic therapies. View Full-Text
Keywords: acute decompensated heart failure; cardiorenal syndrome; central venous pressure; congestive heart failure; congestive renal failure; continuous intravenous furosemide infusion; fluid balance; intravenous chlorothiazide; intravenous decongestive diuresis; Pro B Naturetic Peptide; renal venous pressure; renal venous hypertension; serum creatinine; ultrafiltration acute decompensated heart failure; cardiorenal syndrome; central venous pressure; congestive heart failure; congestive renal failure; continuous intravenous furosemide infusion; fluid balance; intravenous chlorothiazide; intravenous decongestive diuresis; Pro B Naturetic Peptide; renal venous pressure; renal venous hypertension; serum creatinine; ultrafiltration
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Onuigbo, M.A.C.; Agbasi, N.; Sengodan, M.; Rosario, K.F. Acute Kidney Injury in Heart Failure Revisited—The Ameliorating Impact of “Decongestive Diuresis” on Renal Dysfunction in Type 1 Acute Cardiorenal Syndrome: Accelerated Rising Pro B Naturetic Peptide Is a Predictor of Good Renal Prognosis. J. Clin. Med. 2017, 6, 82.

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