ABSTRACT
Current concepts of the development and pathogenesis of cardiorenal syndrome are considered. Special emphasis is laid on the data concerning chronic renal diseases (CRD) as risk factors of cardiovascular disorders (CVD), pathophysiological features of CVD concomitant with CRD, and relationships between CRD and traditional risk factors of CVD. The development of renal dysfunction is regarded as a complication of the heart failure.
Subject(s)
Cardio-Renal Syndrome/physiopathology , Cardiovascular Diseases/physiopathology , Cardio-Renal Syndrome/complications , Cardio-Renal Syndrome/epidemiology , Cardiovascular Diseases/complications , Cardiovascular Diseases/epidemiology , Comorbidity , HumansABSTRACT
OBJECTIVE: Using renal scintigraphy to assess the nephroprotective efficacy of hypoxic preconditioning (HP) during myocardial revascularization under the conditions of artificial circulation (AC). MATERIALS AND METHODS: We examined a total of forty-seven patients with CAD (mean age 52.81 +/- 1.40 years) who endured coronary artery bypass grafting (CABG) under AC. All patients were randomly divided into 2 groups:patients (n = 16) who during CABG underwent HP (study group) and those (n = 31) without renal protection (comparison group). HP was performed in the mode of one cycle of 10-minute hypoxemia followed by a 5-minute period of reoxygenation. Dynamic radionuclide renal scintigraphy with 99mTc-DTPA was carried out before and 6-7 days after surgical treatment with calculating the parameters of the filtrating and excreting renal function. RESULTS: The comparison-group patients after CABG were found to have negative dynamics of the parameters of the renal filtration activity. Thus there was a significant decrease in the mean values of total and individually for each kidney glomerular filtration rate (GFR) combined with deceleration of the blood clearance. Besides patients of this group showed a significant increase in the mean value of the half-period of excretion of the indicator from the pelvicalyceal system of the left kidney and the parenchyma of the both kidneys. The study group patients showed no alterations in the values of the filtration activity of the kidneys as compared with the baseline measures, with the exception of the GFR of the right kidney. Thus a decrease in the filtration function of either one kidney or both kidneys under the influence of non-pulsating blood flow was observed only in three (19%) patients and was not pronounced. Alterations in the indices reflecting the excretory renal function in the study group were also insignificant. CONCLUSION: Radionuclide renal scintigraphy makes it possible to objectively and with a high level of the informative value to determine the degree and pattern of the effect of open-heart surgery on renal functional activity. HPC exerts a nephroprotective effect action on the renal functional activity in patients with endured open-heart surgery in the conditions of assisted circulation.
Subject(s)
Acute Kidney Injury/prevention & control , Extracorporeal Circulation/adverse effects , Ischemic Preconditioning/methods , Kidney , Myocardial Revascularization , Radionuclide Imaging/methods , Acute Kidney Injury/etiology , Acute Kidney Injury/physiopathology , Extracorporeal Circulation/methods , Female , Glomerular Filtration Rate , Humans , Kidney/blood supply , Kidney/diagnostic imaging , Kidney/physiopathology , Male , Middle Aged , Myocardial Revascularization/adverse effects , Myocardial Revascularization/methods , Outcome Assessment, Health Care , Preoperative Care/methods , Technetium Tc 99m Pentetate , Treatment OutcomeABSTRACT
A steady increase in the number of patients diagnosed with chronic cardiac insufficiency determines the importance of studying in such patients the renal function for comprehen sive analysis of the incidence rate and mechanisms of the cardiorenal continuum. Radionuclide methods of diagnosis make it possible to obtain versatile information about the functional state of both the cardiovascular and urinary systems of the body. Radionuclide methods of study were used to prospectively assess the state of the cardiopulmonary haemodynamics and renal functional activity in patients with CAD after previously endured myocardial revascularization. The authors examined a total of twenty-nine patients suffering from coronary artery disease (CAD) (mean age 51.97 +/- 1.32 years) and having developed the NYHA functional class II-III circulatory insufficiency. All the patients were subjected to radiocardiopulmonography (RCPG) with 99mTc-pertechnetate and to dynamic radionuclide renoscintigraphy with 99mTc-DTPA before and after coronary artery bypass grafting (CABG). Fourteen patients were examined 13.0 +/- 0.4 months after surgical management. Prior to CABG, the parameters of the cardiopulmonary haemodynamics in the examined patients had considerable deviations from the normal values, resulting from a decrease in the pumping function of the heart. Prior to surgical management, 83% of the patients were found to have a various-degree decrease in the glomerular filtration rate. Restoration of the coronary blood flow at early terms following CABG along with improved perfusion in the examined patients was accompanied and followed by a positive change in a series of parameters of the cardiopulmonary haemodynamics. One year after direct myocardial revascularization, the patients with circulatory insufficiency were found to have certain relationship between the impairments of the central haemodynamics parameters and the development of renal function impairment. Hence, radionuclide methods of diagnosis should be used while monitoring the patients with circulatory insufficiency for the purposes of timely detection and correction of the cardiorenal syndrome.
