Cheng Shuiqin, Zhou Tingting, Yu Le, Chen Yunmin, Zhang Zhihong, Wang Jinquan, Yu Yusheng
Department of Nephrology, National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
Front Med (Lausanne). 2022 Mar 11;9:817833. doi: 10.3389/fmed.2022.817833. eCollection 2022.
It is difficult to treat cardiorenal syndrome (CRS) in clinical practice, which is the common reason for the death of patients. This report aimed to describe the effects of sacubitril/valsartan treatment on cardiac and renal functions of a patient with cardiorenal syndrome type 4 (CRS4) after more than 3 years of follow-up. A 77-year-old Chinese woman was admitted to our hospital because of CRS4 and stage 5 chronic kidney disease (CKD), who had a history of long-term proteinuria and renal failure. The patient's cardiothoracic ratio (CTR) measured by chest X-ray was 0.6. Cardiac ultrasonography showed that the left ventricular ejection fraction (LVEF) was 0.40. The patient had been treated for heart failure (HF) for 5 months, but there was no improvement in clinical manifestations, and the renal function gradually deteriorated. In our hospital, she received sacubitril/valsartan treatment for at least 40 months. The symptoms of HF relieved, and the indices of cardiac function improved. In addition, the patient's renal function was stable. During the treatment, the dosage of sacubitril/valsartan needed to be adjusted to achieve the optimal therapeutic effect. Follow-up results showed that she achieved cardiac function of New York Heart Association (NYHA) class II with an ejection fraction of 0.60 and E/A > 1 indicated by echocardiogram, and did not develop hyperkalemia. In summary, the improvement of cardiac and renal functions of the CRS4 patient was associated with the long-term sacubitril/valsartan treatment.
在临床实践中，治疗心肾综合征（CRS）颇具难度，这是患者死亡的常见原因。本报告旨在描述沙库巴曲缬沙坦治疗对一名4型心肾综合征（CRS4）患者心脏和肾功能的影响，该患者接受了3年多的随访。一名77岁的中国女性因CRS4和5期慢性肾脏病（CKD）入院，她有长期蛋白尿和肾衰竭病史。胸部X线测量的患者心胸比（CTR）为0.6。心脏超声检查显示左心室射血分数（LVEF）为0.40。该患者已接受心力衰竭（HF）治疗5个月，但临床表现无改善，肾功能逐渐恶化。在我院，她接受了至少40个月的沙库巴曲缬沙坦治疗。HF症状缓解，心功能指标改善。此外，患者的肾功能稳定。治疗期间，需要调整沙库巴曲缬沙坦的剂量以达到最佳治疗效果。随访结果显示，她达到了纽约心脏协会（NYHA）II级心功能，超声心动图显示射血分数为0.60且E/A>1，并且未发生高钾血症。总之，CRS4患者心脏和肾功能的改善与长期沙库巴曲缬沙坦治疗有关。
