Role of Adenosine Antagonism in the Cardiorenal Syndrome

Background: Contrast-induced acute kidney injury (CI-AKI) remains one of the crucial issues related to the development of invasive cardiology. The massive use of contrast media exposes patients to a great risk of contrast-induced nephropathy and chronic kidney disease development, and increases morbidity and mortality rates. The serum creatinine concentration does not allow for a timely and accurate CI-AKI diagnosis; hence numerous other biomarkers of renal injury have been proposed. Renalase, a novel catecholamine-metabolizing amine oxidase, is synthesized mainly in proximal tubular cells and secreted into urine and blood. It is primarily engaged in the degradation of circulating catecholamines. Notwithstanding its key role in blood pressure regulation, renalase remains a potential CI-AKI biomarker, which was shown to be markedly downregulated in the aftermath of renal injury. In this sense, renalase appears to be the first CI-AKI marker revealing an actual loss of renal function and indicating disease severity. Summary: The purpose of this review is to summarize the contemporary knowledge about the application of novel biomarkers of CI-AKI and to highlight the potential role of renalase as a functional marker of contrast-induced renal injury. Key Messages: Renalase may constitute a missing biochemical link in the mutual interplay between kidney and cardiac pathology known as the cardiorenal syndrome.

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The Role of Ultrafiltration in Patients with Decompensated Heart Failure

International Journal of Nephrology ◽

10.4061/2011/190230 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Sandeep A. Kamath

Keyword(s):

Heart Failure ◽

Decompensated Heart Failure ◽

Cardiorenal Syndrome ◽

Loop Diuretics ◽

Inpatient Setting ◽

Effective Volume ◽

Primary Driver ◽

High Doses

Congestion, due in large part to hypervolemia, is the primary driver of heart failure (HF) admissions. Relief of congestion has been traditionally achieved through the use of loop diuretics, but there is increasing concern that these agents, particularly at high doses, may be deleterious in the inpatient setting. In addition, patients with HF and the cardiorenal syndrome (CRS) have diminished response to loop diuretics, making these agents less effective at relieving congestion. Ultrafiltration, a mechanical volume removal strategy, has demonstrated promise in achieving safe and effective volume removal in patients with cardiorenal syndrome and diuretic refractoriness. This paper outlines the rationale for ultrafiltration in CRS and the available evidence regarding its use in patients with HF. At present, the utility of ultrafiltration is restricted to selected populations, but a greater understanding of how this technology impacts HF and CRS may expand its use.

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Clinical relevance of biomarkers in heart failure and cardiorenal syndrome: the role of natriuretic peptides and troponin

Heart Failure Reviews ◽

10.1007/s10741-013-9391-x ◽

2013 ◽

Vol 19 (2) ◽

pp. 267-284 ◽

Cited By ~ 17

Author(s):

Alberto Palazzuoli ◽

Serge Masson ◽

Claudio Ronco ◽

Alan Maisel

Keyword(s):

Heart Failure ◽

Natriuretic Peptides ◽

Clinical Relevance ◽

Cardiorenal Syndrome

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Cardiorenal syndrome: Pathophysiology, preclinical models, management and potential role of uraemic toxins

Clinical and Experimental Pharmacology and Physiology ◽

10.1111/j.1440-1681.2011.05632.x ◽

2012 ◽

Vol 39 (8) ◽

pp. 692-700 ◽

Cited By ~ 15

Author(s):

Shan Liu ◽

Suree Lekawanvijit ◽

Andrew R Kompa ◽

Bing H Wang ◽

Darren J Kelly ◽

...

Keyword(s):

Potential Role ◽

Cardiorenal Syndrome ◽

Preclinical Models

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The Role of Imaging in the Management of Cardiorenal Syndrome

International Journal of Nephrology ◽

10.4061/2011/245241 ◽

2011 ◽

Vol 2011 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Sajid Melvin George ◽

Kambiz Kalantarinia

Keyword(s):

Clinical Utility ◽

Imaging Techniques ◽

Obstructive Uropathy ◽

Kidney Injury ◽

Cardiorenal Syndrome ◽

Renal Ultrasound ◽

Resonance Imaging ◽

Contrast Enhanced ◽

And Function

Imaging of the kidney and the heart can provide valuable information in the diagnosis and management of cardiorenal syndromes. Ultrasound- (US-) based imaging (echocardiogram and renal US) is an essential component in the initial diagnostic workup of CRS. Echocardiography provides information on the structure and function of heart, and renal ultrasound is useful in differentiating between acute and chronic kidney disease and excluding certain causes of acute kidney injury such as obstructive uropathy. In this paper we overview the basic concepts of echocardiogram and renal ultrasound and will discuss the clinical utility of these imaging techniques in the management of cardiorenal syndromes. We will also discuss the role of other imaging modalities currently in clinical use such as computerized tomography and magnetic resonance imaging as well as novel techniques such as contrast-enhanced ultrasound imaging.

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