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Cardiorenal failure: pathophysiology, recognition and treatment

2002; Royal College of Physicians; Volume: 2; Issue: 3 Linguagem: Inglês

10.7861/clinmedicine.2-3-195

1473-4893

Chris Isles,

Blood Pressure and Hypertension Studies

Cardiorenal failure may be defined as pulmonary congestion with serum creatinine 150 μmol/l or higher A rise in creatinine of up to 30% with angiotensin-converting enzyme (ACE) inhibition in patients with heart failure is a normal haemodynamic response and is not a reason to stop the ACE inhibitor Causes of a rise in creatinine of more than 30% with ACE inhibition in patients with heart failure include hypotension, dehydration, bilateral renovascular disease (BRVD), co-prescription of a non-steroidal anti-inflammatory drug and underlying chronic renal failure BRVD should be suspected in patients presenting with hypertension, heart failure and renal failure, particularly if they have vascular disease at other sites, inequality of renal size on ultrasound and ACE inhibitor-induced worsening of their renal function Heart failure may be relieved by renal revascularisation in a proportion of patients with BRVD, particularly those with tight bilateral renal artery stenoses, tight unilateral stenosis with a contralateral occlusion, or tight stenosis to a single functioning kidney.