How is Cardiorenal syndrome type 3 treated

How is Cardiorenal syndrome type 3 treated?

The strategy to manage these patients depends on the stage of Acute Kidney Injury

Patients at high risk of developing Acute Kidney Injury.

Special care should be taken to avoid Acute Kidney Injury. This should include avoiding or minimizing nephrotoxic medications and procedures.

Preventing hypoperfusion, volume depletion, or volume overload is a cornerstone of avoiding AKI.

This is especially important in patients with higher filling pressures and signs of right heart dysfunction due to increased preload.

Stage 1 (risk). 

In addition to the above recommendations, these patients should get a urine analysis, routine blood tests, biomarkers, and a kidney ultrasound to investigate the etiology and to correct problems.

Close monitoring and supportive care should also be provided. ¹

Stage 2 (injury) 

Stage 2 patients are characterized by high risk of morbidity/mortality due to kidney injury. In addition to conservative therapy, these patients should receive functional hemodynamic monitoring to guide resuscitation, especially pulse pressure variation in ventilated patients.

Attention should be paid to the maintenance of electrolytes and acid-base homeostasis. Drug dosing may need to be altered due to the decreased renal clearance.

Stage 3 (failure). 

At this stage patient are at a high risk of death and have a high probability of extrarenal complications, including CRS. RRT may be needed to provide clearance or to avoid life-threatening complications.

The prevention of left ventricular volume overload is critical to maintain adequate cardiac output and systemic perfusion. Continuous infusion of furosemide may be needed to establish and maintain diuresis.

Combining loop diuretics with thiazide diuretics will also increase efficacy.