New Insights into Mechanisms of Acute Kidney Injury in Heart Disease

Publication date: Available online 11 July 2019Source: Canadian Journal of CardiologyAuthor(s): Sriram Sriperumbuduri, Edward Clark, Swapnil HiremathAbstractAcute kidney injury is frequent occurrence in patients with heart disease, and is associated with higher risk of adverse outcomes, including mortality. In the setting of decompensated heart failure, acute kidney injury can occur from haemodynamic and neurohormonal activation, venous congestion, and nephrotoxic medications. Certain medications, such as loop diuretics, renin angiotensin system blockers, and mineralocorticoid antagonists can seemingly cause acute kidney injury. However this rise in creatinine is not always associated with adverse outcomes and should be carefully differentiated so as to allow deliberate continuation of these cardio- and nephro-protective agents. In other settings such as cardiac surgery, acute kidney injury can occur from factors related to the cardiopulmonary bypass, renal hypoperfusion or other perioperative factors. Lastly patients with heart disease commonly undergo imaging procedures which require contrast administration. Contrast can indeed cause acute kidney injury, but these interventional procedures also can result in kidney injury from atheroembolic phenomena. This is well demonstrated by the recent data reporting a higher risk of acute kidney injury from femoral compared to radial access. The advent of biomarkers of kidney injury it presents an opportunity for early detection, accu...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research