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🔥🫀ARNI showed superior cardioprotective effects. May have renoprotective effects as per their molecular mechanism, but the evidence to date applies only to heart failure. Future studies in CKD are needed, perhaps? 🤔

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🔥SGLT2 Inhibitors: Game-changers! They reduce HF hospitalisations, preserve GFR, slow CKD progression and improve outcomes in CRS. 🔹 Trials: DAPA-HF, EMPA-KIDNEY show mortality & renal benefits. Do check out the link for the new SGLT2i toolkit there: theisn.org/initiatives/...

Reposted by Raphael

See here an Evidence Table of RCTs Comparing Pharmacological Therapy for Fluid Overload and UF in Pts With Acute Decompensated HF doi.org/10.1161/CIRC...

Reposted by Raphael

Decongestion Therapy 🔹 Loop diuretics = cornerstone 🔹 Use high doses for diuretic resistance; consider thiazides for synergy. 🔹 UF for refractory cases, but monitor renal function closely. 🔹 Aggressive diuresis improves outcomes even with transient ↑ creatinine.

Reposted by Raphael

Key Principles in Rx 1️⃣ Decongestion (diuretics/ultrafiltration). 2️⃣ Neurohormonal modulation (RAASI, SGLT2i). 3️⃣ Volume assessment (CVP, intrarenal Doppler). 4️⃣ Treat underlying systemic disease (e.g., sepsis). 5️⃣ Multidisciplinary care doi.org/10.3390/hear...

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What about management? CRS management is about balance. It’s a tightrope walk between relieving congestion & preserving renal function. Let’s talk strategies. Here is the strategy for acute cases, doi.org/10.3390/hear...

Reposted by Raphael

Different imaging tech can also provide an overview of tissue damage and the overall function of the heart and kidneys doi.org/10.3390/jpm1...

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🔬 Biomarkers of cardiac and kidney injury may provide important information when and can serve to indicate early cardiac or renal injury, the repair process, and long-term sequelae doi.org/10.1161/CIR.... Here is a list

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How do we diagnose it? doi.org/10.1161/CIRC... We look at: Biomarkers: NT-proBNP, cystatin C, NGAL, KIM-1 Imaging: Echo (CVP, LVEF), renal US (exclude obstruction) Volume status: Clinical exam + POCUS

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Congestion vs Perfusion For years, we thought hypoperfusion drove CRS. 🔥Turns out, congestion is the bigger villain. High venous pressure, intra-abdominal pressure (IAP), and renal compression all hurt GFR. doi.org/10.3389/fphy...

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Cardiorenal Syndrome: Classification, Pathophysiology, Diagnosis, and Treatment Strategies: A Scientific Statement From the American Heart Association | Circulation

🫀🔥Now, the million-dollar question: Why does this happen? —it’s a cocktail of mechanisms: 🩺 Central players: Congestion → ↓ Renal perfusion RAAS & SNS activation → Maladaptive changes Inflammation & oxidative stress → Organ damage doi.org/10.1161/CIR....

doi.org

Cardiorenal syndrome encompasses a spectrum of disorders involving both the heart and kidneys in which acute or chronic dysfunction in 1 organ may induce acute or chronic dysfunction in the other orga...

Reposted by Raphael

🔑What is CRS? nature.com/articles/nrn... Types of CRS: 1️⃣ Type I: Acute HF → AKI 2️⃣ Type II: Chronic HF → CKD 3️⃣ Type III: AKI → Acute HF 4️⃣ Type IV: CKD → Chronic HF 5️⃣ Type V: Systemic diseases (e.g., sepsis) → Combined dysfunction

Reposted by Raphael