Cardiorenal Syndrome: Challenges in Everyday Clinical Practice and Key Points towards a Better Management

Figures

• 

  Figure 1. Assessment of venous congestion in CRS. Fluid overload has been clearly associated with adverse outcomes in critically ill patients such as end-organ damage and therefore, an increased incidence of acute kidney injury. Renal dysfunction developing in the setting of hypervolemia results from a decline in renal venous outflow and hence an increase in renal interstitial pressure. Novel methods of assessing venous congestion are much needed in order to establish effective and timely, appropriate decongestive treatment. Clinical evaluation is a key step for the assessment of volume overload including recurrent weight gain, the development of diuretic resistance (constantly increasing diuretic dose to achieve effective decongestion and/or the need for a combinatory use of diuretics with different modes of action for sequential nephron segment blockade), frequent hospitalizations in order to receive intravenous diuretic therapy, the presence of pleural effusion, peripheral oedema/anasarca, and/or ascites. Inferior vena cava (IVC) is the first venous compartment where congestion becomes apparent. Hepatic venous flow abnormality follows IVC distension with a subsequent development of…