Cardiorenal syndrome. Pouchelon. 2015. JSAP

Question 1

What is type 1 CRS?

Answer 1

type 1, involving acute worsening of heart function leading to kidney injury, such as that occurring in patients with acute congestive heart failure (CHF)

Question 2

What is type 2 CRS?

Answer 2

type 2, involving chronic disease of the heart leading to kidney injury, such as that occurring in patients with chronic heart failure

Question 3

What is type 3 CRS?

Answer 3

type 3, involving acute worsening of kidney function leading to heart injury, such as that in patients with acute kidney injury (AKI)

Question 4

What is type 4 CRS?

Answer 4

type 4, involving chronic kidney disease (CKD) leading to heart injury

Question 5

What is type 5 CRS?

Answer 5

type 5, involving systemic disease(s) leading to simultaneous injury of both the heart and kidney, such as that occurring in patients with sepsis, systemic hypertension or amyloidosis

Question 6

How does the CRS consesus group call CRS?

Answer 6

Cardiovascular Renal Disorder –> to include the vasculature as well

Question 7

What are the most common cardiac diseases in dogs?

Answer 7

• valvular disease
• DCM
• heartworm disease

Question 8

What are the most common cardiac diseases in cats?

Answer 8

• HCM
• other myopathies
• systemic hypertension

Question 9

What are the most common renal diseases in dogs?

Answer 9

• glomerular disease
• pyelonephritis
• acute tubular necrosis
• tubulointerstitial disease

Question 10

What are the most common renal diseases in cats?

Answer 10

• idiopathic chronic end-stage kidney disease with tubulointerstitial fibrosis

Question 11

What does CvRD_H refer to?

Answer 11

CvRDH refers to kidney injury or dysfunction emanating from a primary disease process involving the cardiovascular system.

Question 12

What are potential mechanisms by which CvRD_H causes kidney damage?

Answer 12

• decreased kidney perfusion secondary to decreased cardiac output, hypotension, or cardiac shock
• activation of neuroendocrine systems, namely RAAS and SNS
• abnormal or injured endothelial tissue –> reactive oxygen species
• congestion of the kidney
• systemic arterial thromboembolism –> renal infarction
• systemic hypertension –> glomerular disease

Question 13

describe how CvRD_H affects the hydrostatic glomerular filtration gradient and kidney function

Answer 13

the hydrostatic glomerular filtration gradient is defined as the difference between the glomerular blood pressure and the capsular hydrostatic pressure = influenced by the systemic venous pressure

elevated systemic venous pressure + poor cardiac function –> renal congestion –>

• increases capsular hydrostatic pressure
• decreases glomerular filtration pressure

–> decreases GFR –> decreases kidney function

Question 14

How does Furosemide potentially damage the kidneys?

Answer 14

• volume contraction –> worsening kidney function
• stimulation of the RAAS system
• increases amount of Na reaching the distal tubule –> increases adenosin secretion –> vasoactive mechanisms –> decreases renal function –> contributes to diuretic resistance

Question 15

which 2 factors do in combination predict poor renal tolerance of acute diuresis?

Answer 15

(1) non-dilated left and right ventricles with a steep pressure-volume relationship (e.g. de novo acute heart failure, diastolic heart failure) and
(2) no or minimal peripheral edema

Question 16

What does CVRD_K refer to?

Answer 16

CvRDK refers to cardiovascular injury or dysfunction emanating from a primary disease process involving the kidney

Question 17

describe how CvRD_K affects the cardiovascular system

Answer 17

• drugs used for cardiac disease (e.g., digoxin, enalapril and atenolol) undergo renal excretion and cause primary kidney dysfunction, with reduced drug clearance –> toxicity –> arrhythmias, hypotension and worsening myocardial function
• Fluid volume and haemodynamic status are virtually always abnormal in patients with severe kidney disease
• Kidney injury can also lead to systemic volume overload that contributes to congestion
• SHT is a common sequela to CKD and can result in myocardial hypertrophy and dysfunction
• azotaemia itself may have adverse effects on cardiac myocytes

Question 18

What does CvRD_O refer to?

Answer 18

CvRDO refers to kidney and cardiovascular injury or dysfunction emanating from either a primary disease process outside the two systems or instances in which primary kidney and cardiovascular diseases coexist

e. g., sepsis, infectious disease
e. g., primary glomerular disease and myxomatous mitral valve degeneration

Question 19

What systolic blood pressure indicates progressive risk of end- or target-organ damage

Answer 19

systolic pressure > 160 mm Hg

Question 20

How does SHT affect the kidneys

Answer 20

can result in:

• increased rate of renal injury
• proteinuria
• decreased GFR
• increased incidence of uraemic crisis

Question 22

How does hypotension affect the kidneys?

Answer 22

• reduces tissue perfusion and GFR
• activates maladaptive neurohormonal response

Question 23

name 2 examples of diuretics

Answer 23

• furosemide
• hydrochlorthiazide

Question 24

name 6 examples for vasodilators

Answer 24

• ACEI
• amlodipine
• diltiazem
• nitroglycerin
• hydralazine
• nitroprusside

Question 25

how does renal function affect furosemide efficacy?

Answer 25

furosemide requires active secretion across proximal renal tubular cells in order to reach the lumen and its site of co-transporter binding, so that decreased renal perfusion or tubular injury decreases the expected diuretic response