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      The Role of Imaging in the Management of Cardiorenal Syndrome

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      Author(s): , *
      Publication date (Electronic):
      Journal: International Journal of Nephrology
      Publisher: SAGE-Hindawi Access to Research

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          Abstract

          Imaging of the kidney and the heart can provide valuable information in the diagnosis and management of cardiorenal syndromes. Ultrasound- (US-) based imaging (echocardiogram and renal US) is an essential component in the initial diagnostic workup of CRS. Echocardiography provides information on the structure and function of heart, and renal ultrasound is useful in differentiating between acute and chronic kidney disease and excluding certain causes of acute kidney injury such as obstructive uropathy. In this paper we overview the basic concepts of echocardiogram and renal ultrasound and will discuss the clinical utility of these imaging techniques in the management of cardiorenal syndromes. We will also discuss the role of other imaging modalities currently in clinical use such as computerized tomography and magnetic resonance imaging as well as novel techniques such as contrast-enhanced ultrasound imaging.

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          ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society.

          Sharon Ann Hunt, William T. Abraham, Marshall Chin … (2005)
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            Cardio-renal syndromes: report from the consensus conference of the Acute Dialysis Quality Initiative

            Claudio Ronco, Peter R. McCullough, Stefan D. Anker … (2009)
            A consensus conference on cardio-renal syndromes (CRS) was held in Venice Italy, in September 2008 under the auspices of the Acute Dialysis Quality Initiative (ADQI). The following topics were matter of discussion after a systematic literature review and the appraisal of the best available evidence: definition/classification system; epidemiology; diagnostic criteria and biomarkers; prevention/protection strategies; management and therapy. The umbrella term CRS was used to identify a disorder of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction in the other organ. Different syndromes were identified and classified into five subtypes. Acute CRS (type 1): acute worsening of heart function (AHF–ACS) leading to kidney injury and/or dysfunction. Chronic cardio-renal syndrome (type 2): chronic abnormalities in heart function (CHF-CHD) leading to kidney injury and/or dysfunction. Acute reno-cardiac syndrome (type 3): acute worsening of kidney function (AKI) leading to heart injury and/or dysfunction. Chronic reno-cardiac syndrome (type 4): chronic kidney disease leading to heart injury, disease, and/or dysfunction. Secondary CRS (type 5): systemic conditions leading to simultaneous injury and/or dysfunction of heart and kidney. Consensus statements concerning epidemiology, diagnosis, prevention, and management strategies are discussed in the paper for each of the syndromes.
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              High prevalence of renal dysfunction and its impact on outcome in 118,465 patients hospitalized with acute decompensated heart failure: a report from the ADHERE database.

              J HEYWOOD, Gregg C. Fonarow, Maria Costanzo … (2007)
              The prevalence of renal dysfunction in patients hospitalized with acute decompensated heart failure remains poorly characterized. Data from 118,465 hospitalization episodes were evaluated. Glomerular filtration rate (GFR) was estimated using the abbreviated Modification of Diet in Renal Disease formula. At admission, 10,660 patients (9.0%) had normal renal function (GFR > or = 90 mL x min x 1.73 m2), 32,423 patients (27.4%) had mild renal dysfunction (GFR 60-89 mL x min x 1.73 m2), 51,553 patients (43.5%) had moderate renal dysfunction (GFR 30-59 mL.min.1.73 m2), 15,553 patients (13.1%) had severe renal dysfunction (GFR 15-29 mL x min x 1.73 m2), and 8276 patients (7.0%) had kidney failure (GFR < 15 mL x min x 1.73 m2 or chronic dialysis). Despite this, only 33.4% of men and 27.3% of women were diagnosed with renal insufficiency. Diuretic dose, inotrope use, and nesiritide use increased, whereas angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker use decreased, with increasing renal dysfunction (all P < .0001 across stages). In-hospital mortality increased from 1.9% for patients with normal renal function to 7.6% and 6.5% for patients with severe dysfunction and kidney failure, respectively (P < .0001). The majority of patients admitted with acute decompensated heart failure have significant renal impairment, which influences treatment and outcomes.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Nephrol
                Journal ID (publisher-id): IJN
                Title: International Journal of Nephrology
                Publisher: SAGE-Hindawi Access to Research
                ISSN (Electronic): 2090-2158
                Publication date Collection: 2011
                Publication date (Electronic): 24 January 2011
                Volume: 2011
                Electronic Location Identifier: 245241
                Affiliations
                Division of Nephrology, University of Virginia Health System, P.O. Box 800133, Charlottesville, VA 22908, USA
                Author notes
                *Kambiz Kalantarinia: kk6c@ 123456virginia.edu

                Academic Editor: Claudio Ronco

                Article
                DOI: 10.4061/2011/245241
                PMC ID: 3034942
                PubMed ID: 21318046
                SO-VID: d3da0e7b-6e70-47ce-b340-334418b45bf5
                Copyright © Copyright © 2011 S. M. George and K. Kalantarinia.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 23 August 2010
                Date accepted : 4 January 2011
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Nephrology
                Data availability:
                ScienceOpen disciplines: Nephrology

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