148 research outputs found
Diuretic response and renal function in heart failure
In patients with heart failure fluid overload is a frequently occurring problem, which is among others caused by an impaired function of the heart. This fluid overload may lead to severe dyspnea warranting an acute hospitalization. The first choice treatment of this fluid overload is administration of water pills. The effect of these pills is that excess water is lost with the urine. The research in this thesis showed that a great number of patients do not respond well to this treatment. A poor response is also associated with higher hospitalization and mortality rates and is therefore a great problem. One of the reasons why these patients do not respond well are renal adaptations. This causes an impaired response as these pills act on the kidney. Several biomarkers in the circulation can help in assessing both renal function and response to these water pills. Our research also showed that clincians can already assess response to treatment 24 hours after starting. Future research will have to show whether (additional) treatment with other medications will improve the response and hopefully also survival of these severely diseased patients
The role of the kidney in acute and chronic heart failure
Renal dysfunction affects approximately 30 to 50% of heart failure (HF) patients. The unfavourable relationship between heart and kidney dysfunction contributes to worse outcomes through several mechanisms such as inflammation, oxidative stress, impaired hydrosaline homeostasis, and diuretic resistance. Renal dysfunction not only carries important prognostic value both in acute and in chronic HF, but also is a potential precipitating factor after the first diagnosis. Because renal dysfunction encompasses different etiologies, a better understanding of its definition, incidence, and pathophysiology provides additional information. Although old and novel available biomarkers for the detection of renal dysfunction have been recently proposed, there is no general consensus regarding the terminology and definition of renal dysfunction in HF. Due to some specific pathophysiological mechanisms, renal impairment seems to be different on an individual patient level and, recognizing it in acute and chronic settings, could be useful to optimize decongestive treatment. For these reasons, in this review, we aim to describe and evaluate different phenotypes of renal dysfunction in acute and chronic HF and the possible management in these settings. Key messages center dot Chronic kidney dysfunction and worsening renal function are highly prevalent in acute heart failure and chronic heart failure and associated with poor outcomes. center dot This association is modified by the context in which it occurs, i.e. worsening renal function in the context of adequate decongestion in acute heart failure, or worsening renal function after initiation of neurohormonal blockers in chronic heart failure. center dot Future research should be aimed at elucidating the mechanisms involved in these differenct contexts, as well as alternative treatment approaches in the case of true worsening renal function
A patient with recurrent syncope-it does matter how slow and long you go:Rythm Puzzle - Answer
A patient with recurrent syncope-it does matter how slow and long you go:Rythm Puzzle - Answer
A patient with recurrent syncope-it does matter how slow and long you go:Rythm Puzzle - Answer
A patient with recurrent syncope-it does matter how slow and long you go:Rythm Puzzle - Answer
A patient with recurrent syncope—it does matter how slow and long you go:Rythm Puzzle - Question
A patient with recurrent syncope-it does matter how slow and long you go:Rythm Puzzle - Answer
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