GU/Nephrology - Cardiorenal & Hepatorenal syndromes
1. What is the goal with cardiorenal syndrome?: - Achieving euvolemia
2. What type of cardiac dysfunction leads to cardiorenal syndrome?: - Acute/chronic
HF
- ischemic events
- arrhythmias
3. What is Type I cardiorenal syndrome?: Acute HF leading to AKI (acute cardiorenal syndrome)
4. What is Type 2 cardiorenal syndrome?: Chronic HF leading to progressive and permanent CKD
(chronic cardiorenal syndrome)
5. What is Type 3 cardiorenal syndrome?: AKI causing acute HF
6. What is Type 4 cardiorenal syndrome?: - CKD leading to chronic HF and CKD progression
7. What is Type 5 cardiorenal syndrome?: Systemic insult (severe sepsis or septic shock) leads to
AKI and HF
8. What are the two main factors that causes cardiorenal syndrome?: 1. Poor
perfusion
2. Venous congestion
9. How can poor perfusion cause cardiorenal syndrome?: Inability of the failing heart to
generate forward flow, causing prerenal hypoperfusion:
1/3
, - Inadequate renal AFFERENT flow activates the RAAS axis, the sympathetic nervous system, and ADH secretion, leading
to fluid retention, increased preload, and worsening pump failure
10. How can venous congestion cause cardiorenal syndrome?: Elevated CVPs result in
renal venous hypertension, increased renal resistance, and ultimately impaired intrarenal blood flow (DECREASED
AFFERENT flow)
- the difference between arterial driving pressure and venous outflow pressures must remain suflciently large for
adequate renal blood flow and glomerular filtration
11. What type of imaging can be done for cardiorenal syndrome?: 1. Echocardiography
- measures CVP, systolic PA pressure, pulmonary capillary wedge pressure/left atrial pressure, and EF
2. Renal U/S
- renal size, echogenicity, cortical thickness
12. How is troponin and BNP affected with cardiorenal syndrome?: - high troponin
- patients with CKD have a HIGHER baseline BNP level compared to patients with normal renal function
13. What appears on a BMP for cardiorenal syndrome?: - Increased BUN and Cr
2/3
1. What is the goal with cardiorenal syndrome?: - Achieving euvolemia
2. What type of cardiac dysfunction leads to cardiorenal syndrome?: - Acute/chronic
HF
- ischemic events
- arrhythmias
3. What is Type I cardiorenal syndrome?: Acute HF leading to AKI (acute cardiorenal syndrome)
4. What is Type 2 cardiorenal syndrome?: Chronic HF leading to progressive and permanent CKD
(chronic cardiorenal syndrome)
5. What is Type 3 cardiorenal syndrome?: AKI causing acute HF
6. What is Type 4 cardiorenal syndrome?: - CKD leading to chronic HF and CKD progression
7. What is Type 5 cardiorenal syndrome?: Systemic insult (severe sepsis or septic shock) leads to
AKI and HF
8. What are the two main factors that causes cardiorenal syndrome?: 1. Poor
perfusion
2. Venous congestion
9. How can poor perfusion cause cardiorenal syndrome?: Inability of the failing heart to
generate forward flow, causing prerenal hypoperfusion:
1/3
, - Inadequate renal AFFERENT flow activates the RAAS axis, the sympathetic nervous system, and ADH secretion, leading
to fluid retention, increased preload, and worsening pump failure
10. How can venous congestion cause cardiorenal syndrome?: Elevated CVPs result in
renal venous hypertension, increased renal resistance, and ultimately impaired intrarenal blood flow (DECREASED
AFFERENT flow)
- the difference between arterial driving pressure and venous outflow pressures must remain suflciently large for
adequate renal blood flow and glomerular filtration
11. What type of imaging can be done for cardiorenal syndrome?: 1. Echocardiography
- measures CVP, systolic PA pressure, pulmonary capillary wedge pressure/left atrial pressure, and EF
2. Renal U/S
- renal size, echogenicity, cortical thickness
12. How is troponin and BNP affected with cardiorenal syndrome?: - high troponin
- patients with CKD have a HIGHER baseline BNP level compared to patients with normal renal function
13. What appears on a BMP for cardiorenal syndrome?: - Increased BUN and Cr
2/3
