Seminars in nephrology
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Seminars in nephrology · Jan 2012
Diagnosis and management of fluid overload in heart failure and cardio-renal syndrome: the "5B" approach.
Cardio-Renal syndrome may occur as a result of either primarily renal or cardiac dysfunction. This complex interaction requires a tailored approach to manage the underlying pathophysiology while optimizing the patient's symptoms and thus providing the best outcomes. Patients often are admitted to the hospital for signs and symptoms of congestion and fluid overload is the most frequent cause of subsequent re-admission. ⋯ This stands for balance of fluids (reflected by body weight), blood pressure, biomarkers, bioimpedance vector analysis, and blood volume. Addressing these parameters ensures that the most important issues affecting symptoms and outcomes are addressed. Furthermore, the patient is receiving the best possible care while avoiding unwanted side effects of the treatment.
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Seminars in nephrology · Jan 2012
Neutrophil gelatinase-associated lipocalin curve and neutrophil gelatinase-associated lipocalin extended-range assay: a new biomarker approach in the early diagnosis of acute kidney injury and cardio-renal syndrome.
Cardio-Renal syndrome (CRS) is a common and complex clinical condition in which multiple causative factors are involved. The time window between renal insult and development of acute kidney injury (AKI) in acute heart failure (AHF) can be varied in different patients and AKI often is diagnosed too late, only when the effects of the insult become evident with a loss or decline of renal function. For this reason, pharmaceutical interventions for AKI that have been shown to be renoprotective or beneficial when tested in experimental conditions do not display similar results in the clinical setting. ⋯ We propose that NGAL may increase its usefulness in the diagnosis and prevention of CRS if a curve of plasma values rather than a single plasma measurement is determined. To apply the concept of measuring an NGAL curve in AHF patients, however, assay performance in the lower-range values becomes a critical factor. For this reason, we propose the use of the new extended-range plasma NGAL assay that may contribute to remarkably improve the sensitivity of AKI diagnosis in AHF and lead to more effective intervention strategies.
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Seminars in nephrology · Jan 2012
ReviewThe role of inflammation in the cardio-renal syndrome: a focus on cytokines and inflammatory mediators.
Cardiovascular and kidney diseases are highly prevalent and frequently are seen in the same patient. This overlap between cardiac and kidney diseases, in part, relates to common etiologies such as diabetes and hypertension. ⋯ In this regard, it is clear that inflammation plays an important role in the pathogenesis of both cardiovascular and renal diseases. Given the circulating nature of many inflammatory mediators (cytokines, immune cells), it is tempting to speculate that the immune system can act as a mediator of organ cross-talk and may be involved in the reciprocal dysfunction that is encountered commonly in cardio-renal syndromes.
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Seminars in nephrology · Jan 2012
ReviewRole of biomarkers in the diagnosis and management of cardio-renal syndromes.
The complex interaction between heart and kidney disease has been increasingly recognized over the recent years. Pathologies within these two organs frequently coexist and, due to organ cross-talk, dysfunction in one often leads to problems in the other. ⋯ To aid in the diagnosis, management and prognosis of these conditions, many novel cardiac and renal biomarkers have emerged to supplement traditional markers which have limited specificity and sensitivity. In this review we will summarize the literature on novel renal behind these and other biomarkers and discuss their potential relevance to the clinical scenarios of cardio-renal syndrome.
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Seminars in nephrology · Jan 2012
ReviewCardio-renal syndrome type 3: epidemiology, pathophysiology, and treatment.
A complex pathophysiology, cardio-renal syndrome (CRS), has been redefined in recent years. One subtype is acute renocardiac CRS, or CRS type 3. This syndrome is intended to comprise situations in which acute kidney injury (AKI) results in acute cardiac injury or dysfunction. ⋯ Results obtained from studies using a standard definition of AKI can lead us to the next step of early recognition, prevention, therapeutic intervention, and improved quality of care. Novel biomarkers and therapeutic interventions for primary and secondary disorders are being developed and tested. The hope is that improved outcomes will follow.