Prerenal azotemia in congestive heart failure.

University of California San Diego, San Diego, Calif., USA.
Contributions to nephrology (Impact Factor: 1.53). 01/2010; 164:79-87. DOI: 10.1159/000313723
Source: PubMed

ABSTRACT Prerenal failure is used to designate a reversible form of acute renal dysfunction. However, the terminology encompasses different conditions that vary considerably. The Acute Kidney Injury Network group has recently standardized the acute kidney injury (AKI) definition and classification system; however, these criteria have not determined specific diagnostic criteria to classify prerenal conditions. The difference in the pathophysiology and manifestations of prerenal failure suggests that our current approach needs to be revaluated. Several mechanisms are recognized as contributory to development of a prerenal state associated with cardiac failure. Because of the broad differences in patients' reserve capacity and functional status, prerenal states may be triggered at different time points during the course of the disease. Prerenal state needs to be classified depending on the underlying capacity for compensation, the nature, timing of the insult and the adaptation to chronic comorbidities. Current diagnosis of prerenal conditions is relatively insensitive and would benefit from additional research to define and classify the condition. Identification of high-risk states and high-risk processes associated with the use of new biomarkers for AKI will provide new tools to distinguish between the prerenal and established AKI. Achieving a consensus definition for prerenal syndrome will allow physicians to describe treatments and interventions as well as conduct and compare epidemiological studies in order to better describe the implications of this syndrome.

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    ABSTRACT: Acute kidney injury (AKI) occurs frequently in critical patients, but its clinical relevance has not been determined in decompensated heart failure (DHF). To study the occurrence and prognostic value of AKI in patients with DHF and to compare the clinical and laboratory characteristics and in-hospital mortality with those without AKI. Prospective study of 85 patients hospitalized in intensive care unit (ICU) with DHF from March 2010 to February 2011. Diagnosis of heart failure (HF) was established using the Boston criteria (scale > 8) and additional tests, and AKI was defined using the AKIN classification. Patients data with and without AKI were compared using Student's t-test, chi-squared statistic and multiple logistic regression, considering statistically significant p < 0.05. Most patients were male (55%), valvular disease was the main etiology of HF (42.4%), and inadequate medication was the main cause of decompensation (22.4%). AKI occurred in 76.5% of patients (4.7% stage 1, 32.9% stage 2 and 38.8% stage 3). Patients were more anemic (p = 0.01) and had over 60 years (p = 0.02) in the AKI-group when compared to control. All patients with chronic kidney failure developed AKI. The duration of ICU stay was longer for the AKI group (group AKI 8.8 ± 6.6 days; group non-AKI 4 ± 1.4 days, p < 0.01). In-hospital mortality rate was higher in patients with AKI (p = 0.04), especially in stage 3 (p < 0.01). The duration of ICU stay was an independent predictor of AKI (p = 0.02). Only AKI was considered as independent predictor of mortality in this group (p = 0,05). AKI is frequent in DHF, especially in advanced stages, in the elderly and patients with chronic kidney disease, and was associated with longer hospitalization and higher mortality rate.
    Jornal Brasileiro de Nefrologia 06/2012; 34(2):122-9.

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