RT Book, Section
A1 Redfors, Bjorn
A1 Dordi, Rushad
A1 Ben-Yehuda, Ori
A2 Fuster, Valentin
A2 Harrington, Robert A.
A2 Narula, Jagat
A2 Eapen, Zubin J.
SR Print(0)
ID 1191188870
T1 THE KIDNEY IN HEART DISEASE
T2 Hurst's The Heart, 14e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071843249
LK accessmedicine.mhmedical.com/content.aspx?aid=1191188870
RD 2024/04/24
AB SummaryThis  chapter  discusses  the  relationship  between  kidney  injury  and  heart  disease.  Cardiac  and  renal  physiology  are  closely  related,  and  impaired  cardiac  function  can  lead  to  kidney  injury  and  vice  versa  (see  accompanying  Hurst’s  Central  Illustration).  Impaired  renal  function  has  traditionally  been  classified  into  acute  kidney  injury  (AKI)  and  chronic  kidney  disease  (CKD);  the  latter  syndrome  is  defined  as  persistent  (>3  months)  functional  or  structural  kidney  abnormalities.  AKI  can  occur  when  renal  hemodynamics  become  deranged  secondary  to  acutely  impaired  cardiac  function.  Management  of  cardiovascular  disease  (CVD)  can  also  cause  AKI.  For  example,  contrast-induced  AKI  can  occur  in  patients  undergoing  percutaneous  interventions,  which  require  imaging,  often  repeatedly,  of  the  vasculature,  and  AKI  is  common  after  transcatheter  aortic  valve  replacement  and  after  cardiac  surgery.  Additionally,  chronic  heart  failure  can  lead  to  CKD;  the  pathophysiological  mechanisms  are  incompletely  understood.  In  turn,  CKD  considerably  increases  the  risk  of  developing  CVD.  Autonomic  dysfunction,  vascular  pathology,  and  cardiac  pathology  contribute  to  CVD  progression  in  patients  with  CKD.  Moreover,  CKD  patients  on  dialysis  have  increased  risk  of  pericarditis,  infective  endocarditis,  and  cardiac  arrhythmias.  Management  of  CVD  in  patients  with  CKD  requires  judicious  extrapolation  of  treatment  derived  from  observational  studies  and  with  consideration  of  CKD  pathophysiology.  Notably,  many  cardiovascular  drugs  are  eliminated  from  the  body  by  the  kidneys  and  dose  adjustments  of  some  of  these  drugs  are  therefore  necessary  in  patients  with  CKD.