Onuigbo Macaulay Amechi Chukwukadibia, Agbasi Nneoma, Sengodan Mohan, Rosario Karen Flores
College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Department of Nephrology, Mayo Clinic Health System, Eau Claire, WI 54702, USA.
J Clin Med. 2017 Aug 29;6(9):82. doi: 10.3390/jcm6090082.
There is mounting evidence that forward heart failure as manifested by low cardiac output alone does not define the degree of renal dysfunction in cardiorenal syndrome. As a result, the term "congestive renal failure" was coined in 2012 by Ross to depict the role of renal venous hypertension in type 1 acute cardiorenal syndrome. If so, aggressive decongestive therapies, either through mechanical ultrafiltration with dialysis machines or pharmacologic ultrafiltration with potent diuretics, would lead to improved cardio and renal outcomes. Nevertheless, as recently as 2012, a review of this literature had concluded that a renal venous hypertension-directed approach using diuretics to manage cardio-renal syndrome was yet to be fully investigated. We, in this review, with three consecutive case series, describe our experience with pharmacologic decongestive diuresis in this paradigm of care and argue for studies of such therapeutic interventions in the management of cardiorenal syndrome. Finally, based on our observations in the Renal Unit, Mayo Clinic Health System, in Northwestern Wisconsin, we have hypothesized that patients with cardiorenal syndrome presenting with accelerated rising Pro B Naturetic Peptide levels appear to represent a group that would have good cardio- and renal-outcomes with such decongestive pharmacologic therapies.
越来越多的证据表明，仅以低心输出量表现的前向性心力衰竭并不能界定心肾综合征中肾功能不全的程度。因此，罗斯在2012年创造了“充血性肾衰竭”一词，以描述肾静脉高压在1型急性心肾综合征中的作用。如果是这样，积极的消肿治疗，无论是通过透析机进行机械超滤还是使用强效利尿剂进行药物超滤，都将改善心脏和肾脏的预后。然而，就在2012年，对该文献的一篇综述得出结论，使用利尿剂治疗心肾综合征的肾静脉高压导向方法尚未得到充分研究。在本综述中，我们通过三个连续的病例系列，描述了我们在这种治疗模式下进行药物消肿利尿的经验，并主张对这种治疗干预措施在治疗心肾综合征方面进行研究。最后，基于我们在威斯康星州西北部梅奥诊所健康系统肾脏科的观察，我们推测，心肾综合征患者若呈现前B型利钠肽水平加速上升，似乎代表了一组通过这种消肿药物治疗可获得良好心脏和肾脏预后的人群。
