Effect of the technique for assisting renal blood circulation on ischemic kidney in acute cardiorenal syndrome

Abstract

The technique for assisting renal blood circulation may be a useful therapeutic method in acute cardiorenal syndrome (ACRS), because renal ischemic dysfunction due to the reduced renal blood circulation is a powerful negative prognostic factor in ACRS. We constructed a circuit assisting renal arterial pressure and flow, and performed renal-selective blood perfusion (RSP) to the left kidney in a goat model of ACRS induced by right ventricular rapid pacing (n = 8), with the right kidney left intact as an internal control. Upon induction of ACRS, renal arterial flow (RAF), creatinine clearance (CCr), and renal oxygen consumption (RVO(2)) of the left kidney decreased to 49, 48, and 63% of the respective baseline values accompanied by a significant increase in renal vascular resistance (RVR), and similar results were observed in the right kidney. Then, RSP improved RVR and increased left RAF, CCr, and RVO(2) up to 91, 86, and 93% of baseline values, respectively, without a significant change in systemic hemodynamics. The RSP-treated kidney showed significantly higher CCr and urinary excretion of water and sodium compared to the contralateral kidney. Additional infusion of prostaglandin E(1) with RSP decreased RVR further and enabled the left RAF to increase up to 129% of the baseline value, without a significant change in systemic hemodynamic parameters. The CCr and RVO(2) did not change significantly, and urinary excretion of water and sodium showed a tendency to increase. These findings suggest that the technique for assisting renal blood circulation for both kidneys may offer a new treatment strategy for patients with ACRS.

Preeclampsia: a gestational cardiorenal syndrome

“…In acute situations, these changes are reversible after restoring cardiac functionality (Hanada et al . ). In chronic situations, however, renal ischaemia may occur, with renal tubular cell damage and apoptosis (Bonventre ; Havasi & Borkan, ).…”

“…Impaired cardiac systolic function is responsible for a reduced effective circulatory volume, which in turn leads to renal hypoperfusion with reduced glomerular filtration rate and effective renal plasma flow (Stevenson & Perloff, 1989). In acute situations, these changes are reversible after restoring cardiac functionality (Hanada et al 2012). In chronic situations, however, renal ischaemia may occur, with renal tubular cell damage and apoptosis (Bonventre 2003;Havasi & Borkan, 2011).…”

An Overview of the Role of Calcium/Calmodulin-Dependent Protein Kinase in Cardiorenal Syndrome

“…The presence of acute decompensated HF leads to decreased renal function due to low renal arterial flow and decrease of the glomerular filtration rate. Once hemodynamic parameters are restored, renal and cardiac homeostasis is also restored (Hanada et al, 2012). Type 2 CRS rises as a consequence of chronic abnormalities in cardiac function that cause renal injury or dysfunction.…”

Cardiorenal Syndrome in Acute Coronary Disease: A Current Perspective

“…CRS type 1 is determined by an acute deterioration in heart and kidney function initiated by cardiac damage and has prognostic implications in ACS [5,6]. The main mechanism involved is related to the drop in minute volume that, in addition to systemic hemodynamic disturbances, alters renal perfusion with the consequent decrease in the glomerular filtration rate [7,8].…”