INSERM, Clinical Investigation Center - Unit 1433, Vandoeuvre les Nancy, University of Lorraine.
Vandoeuvre les Nancy,INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy.
Eur J Emerg Med. 2018 Aug;25(4):229-236. doi: 10.1097/MEJ.0000000000000505.
Worsening renal function (i.e. any increase in creatinine or decrease in the estimated glomerular filtration rate) is common in patients admitted for acute heart failure in the emergency department. Although worsening renal function (WRF) has been associated with the occurrence of dismal outcomes, this only appears to be the case when associated with clinical deterioration. However, if the clinical status of the patient is improving, a certain increase in serum creatinine may be acceptable. This WRF, which is not associated with clinical deterioration or adverse outcomes (e.g. during treatment up-titration), has been referred to as 'pseudo-WRF' and should not detract clinicians from targeting 'guideline-recommended' therapies. This is an important message for emergency physicians to pursue diuretics as long as signs of pulmonary congestion persist to improve the clinical status of the patient. In the present review, we aim to provide clinicians in acute settings with an integrative and comprehensive approach to cardiorenal interactions in acute heart failure.
肾功能恶化（即肌酐升高或估计肾小球滤过率降低）在急诊科因急性心力衰竭入院的患者中很常见。虽然肾功能恶化（WRF）与不良结局的发生有关，但这种情况似乎只在与临床恶化相关时才会出现。然而，如果患者的临床状况正在改善，血清肌酐的一定增加可能是可以接受的。这种与临床恶化或不良结局无关的 WRF（例如在治疗滴定期间）被称为“假性 WRF”，不应使临床医生无法针对“指南推荐”的治疗方法。这对于急诊医生来说是一个重要的信息，只要肺部充血的迹象持续存在，就应使用利尿剂来改善患者的临床状况。在本次综述中，我们旨在为急性环境中的临床医生提供一种综合的方法，以了解急性心力衰竭中心肾相互作用。
