Core IM | Internal Medicine Podcast #151 Cardiorenal Considerations: 5 Pearls Segment
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May 13, 2024 Exploring cardiorenal considerations such as diuretic response, loop diuretics, and medical therapy in CKD. Differentiating between cardio-renal syndrome and intrinsic renal processes. Discussing diuretic dosing strategies, assessing response in hospitalized patients, and medication management in CKD.
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Venous Congestion Drives Cardiorenal Syndrome
- Cardiorenal syndrome often involves venous congestion affecting kidney blood flow more than low cardiac output.
- Forward flow may be adequate, but venous congestion blocks blood exit, impairing kidney function.
Use Urinalysis to Confirm Cardiorenal AKI
- A bland urinalysis with no protein or blood supports diagnosis of pure cardiorenal syndrome.
- Always rule out other intrinsic kidney injuries when creatinine rises in heart failure patients.
IV Diuretic Dosing Tips
- For hospitalized patients, IV diuretic dose should be 2.5 times the home oral dose.
- Bolus or continuous infusion is fine; bolus dosing may be preferred for giving kidneys a break.