Kidney pathology in heart failure

According to the data of multicenter studies, disappointing conclusions were obtained: more than 25% of patients with heart failure have kidney pathology, which causes the need for hospitalization for inpatient treatment in 30% of them and is accompanied by early mortality in 67% of cases.

The given data underline the urgency and significance of the problem. A high risk of developing adverse events in the presence of pathology of the kidneys and heart failure was revealed by the scientist E. Braunwald. Read in our article on estet-portal.com the most relevant approaches to the treatment of kidney pathology.

Common features of renal and heart failure

At the same time, the same mechanisms of development are involved in the pathological process: cardiovascular, neurohumoral and genetic factors. This pathogenetic proximity gives the right to consider the processes of heart failure and kidney pathology in a single diagnostic field, with the only difference being that the endpoints of the process are different.

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The pathogenetic proximity of the development of the pathological process requires the cardiologist's comprehensive attention to the state of kidney function in patients with heart failure and outstanding awareness of this issue.

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Measures to prevent kidney pathology

Therefore, the primary clinical task is, first of all, to identify predictors of the development of kidney pathology in heart failure at an early stage, to develop preventive and therapeutic measures aimed at preventing the development of renal dysfunction, to introduce into everyday practice modern methods for diagnosing kidney disorders, as well as the appointment of rational cardiac therapy and reduce the negative impact of drugs on renal activity.

Thus, early diagnosis should be the key to successful treatment, and ideally − prevention of kidney failure in patients with chronic heart failure (CHF).

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Main markers of early kidney dysfunction

1)    Globular Filtration Rate (GFR) − an early marker of kidney dysfunction. GFR ≥150 ml / min / 1.73 m2 should alert the cardiologist and be interpreted as an early sign of kidney pathology.

2)    Albuminuria. Pay special attention to finding out the cause in the presence of such a phenomenon as nocturia.

3)    Bacteriuria and erythrocyturia − a frequent sign of chronic pyelonephritis and dysplastic kidney processes.

4)    Oliguria − a marker of a significant decrease in the filtration capacity of the kidneys.

This is not a complete list of those diagnostic criteria that a doctor should pay attention to and, most importantly, he should be well aware of the problem of kidney dysfunction.

Pathomorphosis of renal dysfunction:

− diabetic nephroangiopathy - 40%;

− stenosing lesions of the arteries of the kidneys of atherosclerotic origin and for account of dysplastic processes - 21%;

− glomerulonephritis and glomerulopathy - 19%;

− cysts, urolithiasis of the kidneys, pathology of the prostate gland and nephrosclerosis -> 6%;

− overweight (morbid obesity) - 4%.

As you can see, the dominant factor in the development of renal dysfunction today is diabetes mellitus, in contrast to past years, when pyelonephritis dominated.

Indicators of kidney dysfunction in the elderly

With age, the GFR decreases and over the age of 60 for men it is 53 ml / min / 1.73 m2 and 49 ml / min / 1.73 m2 for women. GFR depends on the number of working nephrons. The reason for the decrease in the number of functioning nephrons can be different − pathological effects of insulin and increased glucose content in primary urine, a change in the diameter of the afferent and efferent ends of the glomerular capillary, an increase in the pores of the filtration capsule and a detrimental effect on the process of albumin destruction.

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Taking into account the given pathophysiological processes of the formation of kidney pathology will reduce the development of a detrimental process in heart failure by the timely appointment of specific treatment. The use of sartans in case of heart failure and kidney pathology leads to normalization of blood flow in the afferent and efferent capillaries of the glomerulus, a decrease in filtration pressure in it and helps to weaken the destructive effect of albumin on the basement membrane of the glomerulus.

It is sartans that are better able to provide nephroprotection in case of heart failure due to the preservation of functioning nephrons for a long time and protect against the development of premature kidney dysfunction. Normalization of filtration pressure also leads to a decrease in albuminuria and, in combination with the restriction of the use of protein drugs, stops the temporary destruction of nephrons.

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No less important for maintaining GFR at a sufficient level is the choice of a diuretic that can provide smooth natriuresis, diuresis and minimal destruction. It must be remembered that furosemide − an aggressive drug that can cause destruction of the kidneys and lead to a deterioration in survival. Causing excessive natriuresis, the drug causes the accumulation of sodium ions in the nephron capsule with its subsequent destruction. That is why today the drug of choice is torasemide, which is able to provide smooth natriuresis and diuresis without causing nocturia and preserving the kidney from damage.

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All these patients are now being treated and observed by family doctors, so knowledge of the pathology of the kidneys for a doctor is of considerable importance. Considering that kidney dysfunction in patients with heart failure is the dominant comorbidity that can significantly reduce life expectancy and quality of life, timely and adequate treatment aimed at kidney failure can become a priority at all stages of care.

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