Document Detail


Congestive renal failure: the pathophysiology and treatment of renal venous hypertension.
MedLine Citation:
PMID:  23207082     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Longstanding experimental evidence supports the role of renal venous hypertension in causing kidney dysfunction and "congestive renal failure." A focus has been heart failure, in which the cardiorenal syndrome may partly be due to high venous pressure, rather than traditional mechanisms involving low cardiac output. Analogous diseases are intra-abdominal hypertension and renal vein thrombosis. Proposed pathophysiologic mechanisms include reduced transglomerular pressure, elevated renal interstitial pressure, myogenic and neural reflexes, baroreceptor stimulation, activation of sympathetic nervous and renin angiotensin aldosterone systems, and enhanced proinflammatory pathways. Most clinical trials have addressed the underlying condition rather than venous hypertension per se. Interpreting the effects of therapeutic interventions on renal venous congestion are therefore problematic because of such confounders as changes in left ventricular function, cardiac output, and blood pressure. Nevertheless, there is preliminary evidence from small studies of intense medical therapy or extracorporeal ultrafiltration for heart failure that there can be changes to central venous pressure that correlate inversely with renal function, independently from the cardiac index. Larger more rigorous trials are needed to definitively establish under what circumstances conventional pharmacologic or ultrafiltration goals might best be directed toward central venous pressures rather than left ventricular or cardiac output parameters.
Authors:
Edward A Ross
Publication Detail:
Type:  Journal Article     Date:  2012-10-27
Journal Detail:
Title:  Journal of cardiac failure     Volume:  18     ISSN:  1532-8414     ISO Abbreviation:  J. Card. Fail.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-04     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9442138     Medline TA:  J Card Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  930-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
Affiliation:
Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, Florida. Electronic address: Rossea@medicine.ufl.edu.
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