There is no universally accepted definition of AKI, but 3 definitions have been proposed: RIFLE (Risk, Injury, Failure, Loss of kidney function and End Stage Kidney Disease) 7Īnd KDIGO (Kidney Disease: Improving Global Outcomes). Postrenal or obstructive disease is frequently observed in prostatic disease (hyperplasia or cancer) and metastatic cancer. Intrinsic renal disease includes vascular, glomerular, interstitial, and tubular subcategories. Prerenal disease is seen in the context of decreased blood delivery to the kidneys, including HF, shock, acute hemorrhage, severe diarrhea, etc. The other 4 subtypes of CRS are briefly summarized inĪKI is traditionally divided into 3 categories. Additionally, elevated central venous pressure, high intra-abdominal pressure, anemia, and a significant deterioration of immune and somatic cell signaling have been reported as contributors to AKI. The traditional mechanisms of CRS type 1 are low cardiac output, neurohormonal activation, and release of vasoactive substance leading to low renal perfusion. There are 5 subtypes of CRS and each subtype has different pathophysiological mechanisms. Although this was a single-center retrospective cohort study including 371 patients and there were some limitations regarding design and data collection, it does provide important clinical information for physicians treating ADHF patients. The authors speculate that a high BUN/Cr reflects a highly activated neurohormonal system and recommend the continuation of decongestion therapy in ADHF patients with lower BUN/Cr despite an increase of Cr levels, and to consider additional strategies for those with higher BUN/Cr. They also note that the “solo values” of BUN or Cr at admission did not influence the prognostic effect of AKI in ADHF patients. Their study found that ADHF patients with AKI had poorer prognosis when they had a blood urea nitrogen/Cr ratio (BUN/Cr) ≥22.1 at admission. In this issue of the Journal, Takaya et al present a clue as to how physicians make decisions in treating ADHF patients with AKI and also address possible mechanisms of the complex relationship between heart and kidney. ![]() 2Īlthough the development of AKI in ADHF patients had been considered a sign of worse prognosis, some recent studies reported different results. 1ĪKI is the term proposed to reflect the entire spectrum of acute renal failure that occurs in a variety of settings from minimal creatinine (Cr) elevation to anuria. 1ĬRS type 1 appears in 27–40% of patients with acute decompensated heart failure (ADHF) and is characterized by a rapid exacerbation of cardiac function that leads to acute kidney injury (AKI). Heart and kidney have a close bidirectional association known as 5 types of “cardiorenal syndrome (CRS)” in the development and worsening of acute and chronic disorders.
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