Cardiorenal syndromes: Renal artery disease and congestive heart failure

Eric R. Fenstad, Garvan M Kane

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Atherosclerotic renal artery stenosis commonly co-exists with systolic and/or diastolic heart failure and is an unfavorable prognostic indicator. The morbidity and mortality relates to a complex neurohormonal interplay whereby renal ischemia activates the renin angiotensin aldosterone axis resulting in sodium retention, arterial vasoconstriction, and accelerated end-organ damage. In a subset of patients, particularly with bilateral renal artery stenosis, acute episodes of severe hypertension may lead to flash pulmonary edema. Often sharing a common pathophysiology renal artery stenosis is especially common amongst heart failure patients with a 31 % incidence in those who undergo renal artery revascularization. The best course of treatment of renal artery stenosis in the setting of heart failure remains unclear. Although renal artery stenting has no effect on mortality, revascularization may lead to improved control of heart failure as evidenced by a reduction in hospital admissions and improvement in NYHA heart failure class.

Original languageEnglish (US)
Title of host publicationRenal Vascular Disease
PublisherSpringer-Verlag London Ltd
Pages83-101
Number of pages19
ISBN (Print)9781447128106, 1447128095, 9781447128090
DOIs
StatePublished - Dec 1 2013

Keywords

  • Cardiorenal syndrome
  • Diastolic heart failure
  • Flash pulmonary edema
  • Renal artery stenosis
  • Systolic heart failure

ASJC Scopus subject areas

  • Medicine(all)

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    Fenstad, E. R., & Kane, G. M. (2013). Cardiorenal syndromes: Renal artery disease and congestive heart failure. In Renal Vascular Disease (pp. 83-101). Springer-Verlag London Ltd. https://doi.org/10.1007/978-1-4471-2810-6_5