WHEN THE HEART HURTS THE KIDNEYS: THE HIDDEN LINKS

🫀💧 WHEN THE HEART HURTS THE KIDNEYS: THE HIDDEN LINKS💧🫀

Clinical Vignette

A 63-year-old male is admitted to hospital with acute decompensated heart failure secondary to anterior wall MI. He has a history of hypertension and diabetes and is on treatment for the same. His vitals are:


• BP: 100/75 mm Hg; HR: 90 bpm; CVP ~15 mm Hg; peripheral edema (+)
• S. creatinine 1.7 mg/dL; Na 131
• POCUS: LVEF 35%, Ascites and bilateral pleural effusions (+)
• Treatment: IV nitrates and diuretics
Day 1: fluid balance is 2L. Patient remained stable after PCI to LAD.


Day 2: UO 0.4 ml/kg/hour for 5 hours.

Patient remained on 2L oxygen via nasal prongs. His S.creatinine increased to 2.7 mg/dL; peripheral edema persisted.

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1. What is the aetiology of acute kidney injury (AKI) in patients with new onset progressive worsening of heart failure (Cardiorenal syndrome type 1)?
2. How does furosemide help in the management of acute left ventricular dysfunction?
3. How do you titrate diuresis in a patient with acute left ventricular dysfunction receiving furosemide?
4. Which of the following factors are implicated in Diuretic resistance?
5. What is the initial management of diuretic resistance associated with furosemide administration?
6. What is the preferred route of administration of furosemide in patients with Cardiorenal syndrome type 1?
7. Which of the following is a desirable mode of Renal replacement therapy in patients with Cardiorenal syndrome type 1?
8. When should we initiate renal replacement therapy in patients with Cardiorenal syndrome type 1?
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One Response

  1. How to interpret increasing NP values in case of worsening renal function(WRF) whether its due to inadequate decongestion or WRF?

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