Review ArticleCongestive Renal Failure: The Pathophysiology and Treatment of Renal Venous Hypertension
Section snippets
Pressure-Related Effects
Much research has turned from pressure-related and receptor pathways resulting from “forward” HF to those originating from “backward” HF. An isolated rise in renal venous pressure would lower the arteriovenous pressure gradient across the kidney, decrease the renal blood flow, and lower the transglomerular pressure gradients; however, the importance of intrarenal compensatory mechanisms were highlighted when blood flow was experimentally maintained by changes in arterial perfusion or pressure.4
HF and the Cardiorenal Syndrome
Although the renal dysfunction associated with HF has traditionally been attributed to impaired cardiac output and kidney hypoperfusion, this relationship may not hold true across large cohorts of patients. For example, using the ADHERE (Acute Decompensated Heart Failure National Registry) database of 118,465 decompensated HF admissions, Heywood et al were not able to show an association between left ventricular systolic dysfunction and renal impairment.26 Many recent trials have raised the
Treatment of Renal Venous Hypertension and Congestion
In light of the complex pathophysiology, crafting patient care guidelines that incorporate measures of both renal venous hypertension and left ventricular function is difficult and remains controversial. The frequent discordance between the cardiac index and right-sided pressures across the various cardiac disease entities (eg, with right, left, or biventricular dysfunction) might explain why in Mullins et al’s series43 the elevation in right atrial pressure at the time of acutely decompensated
Conclusion
Longstanding observations of the adverse renal effects from venous hypertension have been explained by multiple pathophysiologic mechanisms, ranging from direct pressure to baroreceptor, neural, cytokine, systemic, and local hormonal factors. Relevant clinical entities include the cardiorenal syndrome in congestive HF, disorders (eg, renal, hepatic, or vena caval) of venous pressure or thromboses, and intra-abdominal hypertension. Renal congestion may also be an integral consequence of acute
Disclosures
None.
References (67)
- et al.
Intrarenal distribution of blood flow and renin release during renal venous pressure elevation
Kidney Int
(1973) - et al.
High prevalence of renal dysfunction and its impact on outcome in 118,465 patients hospitalized with acute decompensated heart failure: a report from the ADHERE database
J Card Fail
(2007) - et al.
Cardiorenal interactions: insights from the ESCAPE trial
J Am Coll Cardiol
(2008) - et al.
Increased central venous pressure is associated with impaired renal function and mortality in a broad spectrum of patients with cardiovascular disease
J Am Coll Cardiol
(2009) - et al.
Tricuspid regurgitation contributes to renal dysfunction in patients with heart failure
J Card Fail
(2008) - et al.
Third heart sound and elevated jugular venous pressure as markers of the subsequent development of heart failure in patients with asymptomatic left ventricular dysfunction
Am J Med
(2003) - et al.
Importance of venous congestion for worsening of renal function in advanced decompensated heart failure
J Am Coll Cardiol
(2009) - et al.
Effect of right ventricular function and venous congestion on cardiorenal interactions during the treatment of decompensated heart failure
Am J Cardiol
(2010) - et al.
Diuretics and ultrafiltration in acute decompensated heart failure
J Am Coll Cardiol
(2012) - et al.
Eplerenone survival benefits in heart failure patients post–myocardial infarction are independent from its diuretic and potassium-sparing effects. Insights from an EPHESUS (Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study) substudy
J Am Coll Cardiol
(2011)
Na+, K+, and BP homeostasis in man during furosemide: effects of prazosin and captopril
Kidney Int
Elevated intra-abdominal pressure in acute decompensated heart failure: a potential contributor to worsening renal function?
J Am Coll Cardiol
Effect of hemodialysis on intra-abdominal pressure
Clinics (Sao Paulo)
Circulatory response to fluid overload removal by extracorporeal ultrafiltration in refractory congestive heart failure
J Am Coll Cardiol
Ultrafiltration in moderate heart failure. Exercise oxygen uptake as a predictor of the clinical benefits
Chest
Sustained improvement in functional capacity after removal of body fluid with isolated ultrafiltration in chronic cardiac insufficiency: failure of furosemide to provide the same result
Am J Med
Use of a novel ultrafiltration device as a treatment strategy for diuretic resistant, refractory heart failure: initial clinical experience in a single center
J Card Fail
Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure
J Am Coll Cardiol
Novel therapeutic option for refractory heart failure in elderly patients with chronic kidney disease by incremental peritoneal dialysis
J Cardiol
The influence of venous pressure on the isolated mammalian kidney
J Physiol
Renal venous pressure in chronic congestive heart failure
J Clin Invest
Raised venous pressure: a direct cause of renal sodium retention in oedema?
Lancet
Effect of increased renal venous pressure on circulatory autoregulation of isolated dog kidneys
Circ Res
Micropuncture study of pressures in proximal tubules and peritubular capillaries of the rat kidney and their relation to ureteral and renal venous pressures
Am J Physiol
Renal effects of angiotensin II inhibition during increases in renal venous pressure
Hypertension
Systemic arterial and venous determinants of renal hemodynamics in congestive heart failure
Heart Fail Rev
Renal vascular adjustments to partial renal venous obstruction in dog kidney
Circ Res
Reduction in renal blood flow following acute increase in the portal pressure: evidence for the existence of a hepatorenal reflex in man?
Gut
Splenorenal reflex modulates renal blood flow in the rat
J Physiol
Splenic reflex modulation of central cardiovascular regulatory pathways
Am J Physiol Regul Integr Comp Physiol
Myogenic vasoconstriction in the rat kidney elicited by reducing perirenal pressure
Acta Physiol Scand
Renal interstitial pressure and tubuloglomerular feedback control in rats during infusion of atrial natriuretic peptide (ANP)
Acta Physiol Scand
Effect of increased renal venous pressure on renal function
Am J Physiol
Cited by (0)
See page 936 for disclosure information.