Andersons pediatric cardiology 2092
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Abstract
Thecomplexinterplaybetweenthecardiovascularandrenalsystemshas
receivedsignificantclinical,translational,andbasicresearchattentionover
thepast2decades.Inboththeacuteandchroniccaresettings,dysfunction
ofeithertheheartorthekidneyscanleadtodysfunctionoftheotherorgan.
Whilethisinteractionhasbeenobviousandwellknowninseverecases
(e.g.,advancedkidneyfailureleadingtohyperkalemiaandresultantcardiac
dysrhythmias),recentunderstandingoflesssevereorevensubclinical
interactionswithprofoundbidirectionaleffectshavebeenrealized.This
chapterreviewstheseinteractionsundertheconstructofthecardiorenal
syndromes,withafocusonacuteandchronicrenalconsequencesofcardiac
disease,andonpotentialnoveldiagnosticandtherapeuticmaneuversto
improvepatientoutcomes.
Keywords
Cardiorenalsyndrome;acutekidneyinjury;children;heartfailure;dialysis
Introduction
Thecomplexinterplaybetweenthecardiovascularandrenalsystemshas
receivedsignificantclinical,translational,andbasicresearchattentionoverthe
past2decades.Inboththeacuteandchroniccaresettings,dysfunctionofeither
theheartorthekidneyscanleadtodysfunctionoftheotherorgan.Whilethis
interactionhasbeenobviousandwellknowninseverecases(e.g.,advanced
kidneyfailureleadingtohyperkalemiaandresultantcardiacdysrhythmias),
recentunderstandingoflesssevereorevensubclinicalinteractionswith
profoundbidirectionaleffectshavebeenrealized.
Thischapterreviewstheseinteractionsundertheconstructofthecardiorenal
syndromes,withafocusonacuteandchronicrenalconsequencesofcardiac
disease,andonpotentialnoveldiagnosticandtherapeuticmaneuverstoimprove
patientoutcomes.
ClassificationoftheCardiorenal
Syndromes
TheAcuteDialysisQualityInitiativeconvenedaconsensusconferencein20081
tocodifyheart-kidneyinteractionsintofivedistinctcardiorenalsyndrome
categories(Table78.1).Thecardiorenalsyndromesarecategorizedaseither
acuteorchronic,andwhethertheheartorkidneyistheprimaryorganthatis
injured,orwhetherbothareinjuredsecondarytoasystemicprocess.
Table78.1
ClassificationofCardiorenalSyndromeTypesandAssociated
ClinicalSyndromes
1
Acute
Primary
Secondary
Dysfunction Dysfunction
Cardiac
AKI
2
Chronic
Cardiac
AKIorCKD
3
Acute
Renal
Acuteheart
dysfunctionor
injury
4
Chronic
Renal
Chroniccardiac
dysfunction
5
Acute/Chronic Systemic
Type TimeCourse
Both
ClinicalSyndromes
Acutedecompensatedheartfailure
Cardiogenicshock
Acutecoronarysyndrome
LVdysfunction
Diastolicdysfunction
Cardiomyopathy
Cardiopulmonarybypass
Primaryacutekidneydiseaseleadingtovolume
overload/electrolytedisturbance
Contrastnephropathy
Chronichypertension
Cardiaccalcifications
Leftventricularhypertrophy
Systemiccollagenvasculardisease
Oncologicdisease
Sepsis
AKI,Acutekidneyinjury;CKD,chronickidneydisease;LV,leftventricular.
AcuteCardiorenalSyndromes:Type1andType
3
Theacutecardiorenalsyndromespresentsignificantchallengesinpatient
managementbecauserecognitionofacutediseasecanbedelayed,and
interventionscanbeinvasiveandsometimesexacerbatetheclinicalproblem.
