Treatment and Options

Cardiorenal syndrome

Cardiorenal syndrome describes linked dysfunctions in the cardiac and renal organ systems. Ailing hearts struggle to deliver blood and oxygen to other organs and can become congested, causing a buildup of pressure in the venous system. Over time, a reduced supply of oxygenated blood combined with higher venous pressures can damage kidneys. Renal impairment can also develop after heart transplantation, either as a result of the underlying cardiac disease or due to some of the treatments the transplant requires. In reverse, dysfunctional kidneys can lead to the build-up of toxic metabolites, fluid overload, elevated blood pressures and neurohumoral changes, which can cause decreased cardiac function.

Diagnosis

We perform several tests to help diagnose or anticipate renal problems arising from heart failure or transplant. First, urinary tests help us assess hydration and concentrating ability and to look for traces of blood and protein that indicate renal dysfunction. Similarly, blood tests allow us to assess renal excretory efficiency and to determine if kidney dysfunction has caused additional systemic sequelae. In addition, we use ultrasound and other imaging studies to explore the size and appearance of the kidneys. As additional measures of renal function and injury (serum and urinary biomarkers) have become available, we have implemented them effectively, as well. Having on-site heart and kidney experts communicating with each other in real time helps us both order the most relevant and telling diagnostic tests and interpret the results of those tests in a way that addresses the subtleties of each organ system and their interactive responses.

Management

Balancing cardiorenal patients’ fluid status can be especially challenging because the heart often prefers a reduced volume of fluids, while the kidneys prefer more hydration. The ability to coordinate decisions about hydration with experts on both organ systems allows us to reach an optimal balance and improve care. Through a variety of medical therapies, we also work to control the superabundance of protein many cardiorenal syndrome patients have in their urine. If patients are suffering from hypertension, we help manage that, too. We minimize exposure to any medications known to be toxic to the kidneys, swapping nephrotoxins out whenever safer substitutes exist. Finally, in some cases, heart failure or heart transplantation patients may benefit from kidney transplantation or even a combined heart-kidney transplant. The assembled expertise at the Pediatric Cardiorenal Program helps us identify those patients early to streamline and improve their care.