Giamouzis Gregory, Butler Javed, Triposkiadis Filippos
Department of Cardiology, Larissa University Hospital, Greece.
Congest Heart Fail. 2011 Jul-Aug;17(4):180-8. doi: 10.1111/j.1751-7133.2011.00240.x. Epub 2011 Jul 21.
Despite recent advances with neurohormonal antagonists and devices, the prognosis of patients with advanced heart failure (HF) remains grave. Renal dysfunction is a common comorbid condition in HF and is associated with adverse outcomes. Current evidence indicates that intrinsic renal disease and inflammation in HF makes the kidney susceptible to hemodynamic compromise and congestion and contributes to a great extent to the development of renal dysfunction. Relief of congestion requires combination treatment with diuretics, neurohormonal antagonists, and occasionally vasodilators as well as inotropes. However, high doses of diuretics may accelerate the development of renal dysfunction by increasing neurohumoral activity and inducing renal structural and functional changes. Ultrafiltration should be reserved for patients with true diuretic resistance. Finally, early identification of the "patient at risk" remains a challenging issue and is limited by the currently used conventional parameters of renal function. However, novel biomarkers of acute kidney ischemia and/or injury are emerging and promise to become a diagnostic option for this patient population.
尽管最近在神经激素拮抗剂和器械方面取得了进展，但晚期心力衰竭（HF）患者的预后仍然严峻。肾功能不全是HF常见的合并症，且与不良预后相关。目前的证据表明，HF中的内在肾脏疾病和炎症使肾脏易受血流动力学损害和充血影响，并在很大程度上促成肾功能不全的发展。缓解充血需要利尿剂、神经激素拮抗剂联合治疗，偶尔还需要血管扩张剂和正性肌力药物。然而，高剂量利尿剂可能通过增加神经体液活性并诱导肾脏结构和功能改变来加速肾功能不全的发展。超滤应保留给真正存在利尿剂抵抗的患者。最后，早期识别“高危患者”仍然是一个具有挑战性的问题，并且受到目前使用的传统肾功能参数的限制。然而，急性肾缺血和/或损伤的新型生物标志物正在出现，并有望成为这一患者群体的诊断选择。
