Diuretics & Cardiorenal Syndrome

Cardiorenal

Cardiorenal syndrome (CRS) is caused by several pathophysiological mechanisms, notably congestion of the renal venous vasculature. Loop diuretics are the cornerstone of the treatment of CRS for effecting natriuresis, net negative salt and water balance, and extracellular volume reduction.

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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 logo

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.