Document Detail

Renal adaptation to the failing heart. Avoiding a 'therapeutic misadventure'.
MedLine Citation:
PMID:  8202420     Owner:  NLM     Status:  MEDLINE    
Systolic dysfunction of the heart represents a state of "prerenal" azotemia, in which the excess of total body salt and water is redistributed to venous and interstitial fluid compartments. This results in a diminished effective circulating blood volume and thereby decreases tissue perfusion. The kidneys perceive the ineffective circulating volume and employ a complex series of interconnected hemodynamic and neurohumoral effector mechanisms to restore "adequate" perfusion. This is done by reclaiming a greater fraction of filtered sodium and water and elevating systemic vascular resistance to keep perfusion pressure to vital organs constant despite diminished cardiac output. Knowledge of the physiologic compensatory responses that occur in the kidneys of heart failure patients allows clinicians to develop a logical treatment plan. This knowledge should also help avoid a therapeutic misadventure by making it possible to exclude drugs known to adversely affect renal function in patients with a failing heart and poorly compensating kidneys.
D J Riley; M Weir; G L Bakris
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Postgraduate medicine     Volume:  95     ISSN:  0032-5481     ISO Abbreviation:  Postgrad Med     Publication Date:  1994 Jun 
Date Detail:
Created Date:  1994-07-06     Completed Date:  1994-07-06     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0401147     Medline TA:  Postgrad Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  153-6     Citation Subset:  AIM; IM    
Department of Preventive Medicine, Rush-Presbyterian-St Luke's Medical Center, Chicago, IL 60612.
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MeSH Terms
Adaptation, Physiological*
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
Diuretics / therapeutic use
Dopamine / therapeutic use
Drug Therapy, Combination
Heart Failure / complications*,  drug therapy*,  physiopathology
Kidney Diseases / drug therapy*,  etiology*,  physiopathology
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Anti-Inflammatory Agents, Non-Steroidal; 0/Diuretics

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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