Understanding Cardiorenal syndrome
Cardiorenal syndrome describes a spectrum of conditions in which dysfunction of the heart or kidneys causes the other organ to also fail, leading to a cascading state of multiorgan failure and volume overload. The first management step is usually initiation or escalation of diuretics, although sometimes medications (i.e. inotropes) and devices to increase cardiac function or dialysis may be required. Nephrologists are often asked to assist with diuretic management, kidney injury, and dialysis if needed in these cases.
While on your nephrology rotation, you will likely see many cases of cardiorenal syndrome. This may be on general consult services or on the Kidney-Heart Service at UW Montlake. To help tackle these cases, it is important to have a foundational understanding of diuretic physiology and indications.
The Internet Book of Clinical Care Deresuscitation: Dominating the Diuresis
Josh Farkas
We recommend you read the following chapter from the Internet Book of Critical Care, which provides some clear algorithms for approaches to diuretic management, diuretic side effects, and physiology of the various drug classes.
Diuretics in States of Volume Overload:
Core Curriculum 2022
James E. Novak and David H. Ellison
Next, you can read through the following Core Curriculum from AJKD about approaches to diuretics in states of volume overload.
Cardio Nerds - Episode #154
Cardiology vs Nephrology: A Diuretic Showdown
with Dr. Michael Felker & Dr. Matt Sparks
This “Cardio Nerds” podcast features a nephrologist and cardiologist walking through their approaches to diuretic management.
Cardio Nerds - Episode #262
CCC: Management of Cardiorenal Syndrome in the CICU
with Dr. Nayan Arora & Dr. Elliott Miller
Finally, if you’d like a more in-depth discussion of cardiorenal syndrome in critically ill cardiac ICU patients, please listen to this “Cardio Nerds” episode featuring Dr. Nayan Arora. This would be especially relevant if rotating on the Kidney-Heart service.