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Cardiorenal and hepatorenal syndromes.

Key Concepts

1. To decrease inconsistency and confusion, the Acute Dialysis Quality Initiative (ADQI) defines cardiorenal syndrome as disorders of the heart and kidneys, whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other.

2. Cardiorenal syndrome (CRS) is classified into five subtypes, which designate the originating organ dysfunction and also categorize according to the acute or chronic nature of the organ dysfunction.

3. Type 1 CRS most often appears in acute decompensated heart failure, and patients may present with four different hemodynamic profiles termed wet or dry (the degree of perfusion) and warm or cold (the degree of congestion).

4. Type 3 CRS pathophysiology is related to the cause of the acute kidney injury (AKI), such as contrast-induced AKI, drug-induced AKI, major surgery, cardiac surgery, rhabdomyolysis, and postobstructive uropathy.

5. Biomarkers, objectively measured and evaluated indicators specific to heart failure and kidney injury, are increasingly important in diagnosing CRS.

6. Hepatorenal syndrome (HRS) is defined as acute kidney injury in the presence of either acute liver failure or chronic liver disease, where there is no identifiable cause of the kidney injury.

7. HRS is classified into two types. Type 1 involves rapid deterioration in kidney function with a relatively graver prognosis than type 2, which tends to present with a steady but moderate deterioration in kidney function.

8. HRS may be caused by bacterial infections, diarrhea and vomiting, diuretics, gastrointestinal bleeding, or large-volume paracentesis without adequate blood volume expansion. Half of the cases of HRS are spontaneous.

9. Liver transplantation is an option for treating HRS. ADQI recommendations are for liver transplant alone for type 1 HRS less than 4 weeks in duration, and combination liver-kidney transplant for those at risk for nonrecovery of kidney function.

Cardiorenal Syndrome

Cardiorenal syndrome (CRS) is a comprehensive term that describes the interaction of many diseases related to both the heart and the kidney. Whether the original source is cardiac or kidney dysfunction, the result is a condition known as cardiorenal syndrome (Ronco & DiLullo, 2014). Cardiac disease can often lead to deteriorating kidney function; the opposite is also true, whereby decreased kidney function leads to cardiac dysfunction or disease. Diseases of the heart and kidney are singularly common within our population and often coexist, leading to significant morbidity and mortality. As diagnosis and treatment can be long and complex, the cost of care can also be significant (House et al., 2010).

Definition

A consensus definition was developed to decrease inconsistency and confusion as well as to develop multidisciplinary approaches to identification and treatment. A collaborative conference, Acute Dialysis Quality Initiative (ADQI), with leading experts in nephrology, critical care, cardiac surgery, cardiology, and epidemiology, resulted in a common definition and classification term of cardiorenal syndromes. The term was defined as "disorders of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other" (House et ah, 2010, p. 1418).

In addition, five subtypes of the cardiorenal syndromes were identified and defined: acute cardiorenal syndrome (type 1), chronic cardiorenal syndrome (type 2), acute renocardiac syndrome (type 3), chronic renocardiac syndrome (type 4), and secondary cardiorenal syndrome (type 5) (House et al., 2010). The updates in the definition and classification system allowed a more unified approach to development of prevention and therapeutic strategies that may reduce organ damage (Ronco & Ronco, 2012).
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Title Annotation:CHAPTER 22
Author:Russell, Cynthia L.; Aholt, Dana
Publication:Nephrology Nursing Journal
Article Type:Disease/Disorder overview
Date:Jan 1, 2017
Words:562
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