title: Can we prevent or treat renal dysfunction in acute heart failure?
abstract: Most patients with heart failure (HF) already have or develop renal dysfunction; this might contribute to their poor outcome. Current treatment for HF can also contribute to worsen renal function. High furosemide doses are traditionally associated with worsening renal function (WRF), but patients with fluid overload may benefit of aggressive fluid removal. Unfortunately, promising therapies like vasopressin antagonists and adenosine antagonists have not been demonstrated to improve outcomes. Likewise, correction of low renal blood flow through dopamine, inotropic agents, or vasodilators does not seem to be associated with a clear benefit. However, transient WRF associated with acute HF treatment may not necessarily portend a poor prognosis. In this review, we focus on the strategies to detect renal dysfunction in acute HF, the underlying pathophysiological mechanisms, and the potential treatments.
authors.affiliation: Department of Experimental and Applied Medicine, Section of Cardiovascular Diseases, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy. valentina.lazzarini@gmail.com
authors.forename: Valentina
authors.initials: V
authors.lastname: Lazzarini
authors.forename: Luca
authors.initials: L
authors.lastname: Bettari
authors.forename: Silvia
authors.initials: S
authors.lastname: Bugatti
authors.forename: Valentina
authors.initials: V
authors.lastname: Carubelli
authors.forename: Carlo
authors.initials: C
authors.lastname: Lombardi
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.forename: Livio
authors.initials: L
authors.lastname: Dei Cas
mesh_terms: D000208:Acute Disease; D000241:Adenosine / Q000037:antagonists & inhibitors; D015415:Biomarkers / Q000378:metabolism; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004298:Dopamine / Q000627:therapeutic use; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000188:drug therapy / Q000209:etiology*; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D011379:Prognosis; D014665:Vasodilator Agents / Q000627:therapeutic use*; D014667:Vasopressins / Q000037:antagonists & inhibitors
chemical_list: D015415:Biomarkers; D002316:Cardiotonic Agents; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists; D014665:Vasodilator Agents; D014667:Vasopressins; D000241:Adenosine; D004298:Dopamine