Decongestive diuresis using combination intravenous loop diuretics plus chlorothiazide in type 1 acute cardiorenal syndrome and worsening acute kidney injury; a neglected paradigm in resource-poor settings

Over the last decade or more, there has grown a body of evidence demonstrating that renal dysfunction in heart failure is a combination of forward failure from reduced cardiac output and therefore reduced glomerular filtration rate, as well as "congestive renal failure" secondary to renal...

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Autor principal:	Macaulay Amechi Chukwukadibia Onuigbo
Formato:	article
Lenguaje:	EN
Publicado:	Society of Diabetic Nephropathy Prevention 2020
Materias:	acute kidney injury congestive renal failure loop diuretics resource-poor settings thiazide diuretics type i acute cardiorenal syndrome Therapeutics. Pharmacology RM1-950 Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/18401c70f1cb4d9ca3577a3ce69cfc1d
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spelling	oai:doaj.org-article:18401c70f1cb4d9ca3577a3ce69cfc1d2021-11-17T08:13:31ZDecongestive diuresis using combination intravenous loop diuretics plus chlorothiazide in type 1 acute cardiorenal syndrome and worsening acute kidney injury; a neglected paradigm in resource-poor settings2345-420210.34172/npj.2020.13https://doaj.org/article/18401c70f1cb4d9ca3577a3ce69cfc1d2020-05-01T00:00:00Zhttps://jnephropharmacology.com/PDF/npj-4296https://doaj.org/toc/2345-4202Over the last decade or more, there has grown a body of evidence demonstrating that renal dysfunction in heart failure is a combination of forward failure from reduced cardiac output and therefore reduced glomerular filtration rate, as well as "congestive renal failure" secondary to renal venous hypertension. We had demonstrated the efficacy of combination intravenous loop diuretics used concurrently with intravenous chlorothiazide to achieve significant renal salvage in such patients at the Mayo Clinic Health System in Northwestern Wisconsin. We describe a similar recent experience with three consecutive elderly patients at the University of Vermont Medical Center, Burlington, VT, USA. We posit that this paradigm of care is underutilized. We argue that aggressive decongestive therapy with combination intravenous loop and thiazide diuretics is a neglected and underutilized mechanism and must be utilized more frequently in the treatment of worsening renal failure with type 1 cardiorenal syndrome. This imperative is even most compelling in resource-poor settings where mechanical ultrafiltration with dialysis or similar machines is not available or simply not affordable. Moreover, we had also demonstrated that accelerated rising Pro B natriuretic peptide (Pro-BNP) in such patients portends a good prognosticator for renal salvage. We present here three consecutive elderly patients recently so managed successfully at the University of Vermont Medical Center in Burlington, VT, USA.Macaulay Amechi Chukwukadibia OnuigboSociety of Diabetic Nephropathy Prevention articleacute kidney injurycongestive renal failureloop diureticsresource-poor settingsthiazide diureticstype i acute cardiorenal syndromeTherapeutics. PharmacologyRM1-950Diseases of the genitourinary system. UrologyRC870-923ENJournal of Nephropharmacology, Vol 9, Iss 2, Pp e13-e13 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	acute kidney injury congestive renal failure loop diuretics resource-poor settings thiazide diuretics type i acute cardiorenal syndrome Therapeutics. Pharmacology RM1-950 Diseases of the genitourinary system. Urology RC870-923
spellingShingle	acute kidney injury congestive renal failure loop diuretics resource-poor settings thiazide diuretics type i acute cardiorenal syndrome Therapeutics. Pharmacology RM1-950 Diseases of the genitourinary system. Urology RC870-923 Macaulay Amechi Chukwukadibia Onuigbo Decongestive diuresis using combination intravenous loop diuretics plus chlorothiazide in type 1 acute cardiorenal syndrome and worsening acute kidney injury; a neglected paradigm in resource-poor settings
description	Over the last decade or more, there has grown a body of evidence demonstrating that renal dysfunction in heart failure is a combination of forward failure from reduced cardiac output and therefore reduced glomerular filtration rate, as well as "congestive renal failure" secondary to renal venous hypertension. We had demonstrated the efficacy of combination intravenous loop diuretics used concurrently with intravenous chlorothiazide to achieve significant renal salvage in such patients at the Mayo Clinic Health System in Northwestern Wisconsin. We describe a similar recent experience with three consecutive elderly patients at the University of Vermont Medical Center, Burlington, VT, USA. We posit that this paradigm of care is underutilized. We argue that aggressive decongestive therapy with combination intravenous loop and thiazide diuretics is a neglected and underutilized mechanism and must be utilized more frequently in the treatment of worsening renal failure with type 1 cardiorenal syndrome. This imperative is even most compelling in resource-poor settings where mechanical ultrafiltration with dialysis or similar machines is not available or simply not affordable. Moreover, we had also demonstrated that accelerated rising Pro B natriuretic peptide (Pro-BNP) in such patients portends a good prognosticator for renal salvage. We present here three consecutive elderly patients recently so managed successfully at the University of Vermont Medical Center in Burlington, VT, USA.
format	article
author	Macaulay Amechi Chukwukadibia Onuigbo
author_facet	Macaulay Amechi Chukwukadibia Onuigbo
author_sort	Macaulay Amechi Chukwukadibia Onuigbo
title	Decongestive diuresis using combination intravenous loop diuretics plus chlorothiazide in type 1 acute cardiorenal syndrome and worsening acute kidney injury; a neglected paradigm in resource-poor settings
title_short	Decongestive diuresis using combination intravenous loop diuretics plus chlorothiazide in type 1 acute cardiorenal syndrome and worsening acute kidney injury; a neglected paradigm in resource-poor settings
title_full	Decongestive diuresis using combination intravenous loop diuretics plus chlorothiazide in type 1 acute cardiorenal syndrome and worsening acute kidney injury; a neglected paradigm in resource-poor settings
title_fullStr	Decongestive diuresis using combination intravenous loop diuretics plus chlorothiazide in type 1 acute cardiorenal syndrome and worsening acute kidney injury; a neglected paradigm in resource-poor settings
title_full_unstemmed	Decongestive diuresis using combination intravenous loop diuretics plus chlorothiazide in type 1 acute cardiorenal syndrome and worsening acute kidney injury; a neglected paradigm in resource-poor settings
title_sort	decongestive diuresis using combination intravenous loop diuretics plus chlorothiazide in type 1 acute cardiorenal syndrome and worsening acute kidney injury; a neglected paradigm in resource-poor settings
publisher	Society of Diabetic Nephropathy Prevention
publishDate	2020
url	https://doaj.org/article/18401c70f1cb4d9ca3577a3ce69cfc1d
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Decongestive diuresis using combination intravenous loop diuretics plus chlorothiazide in type 1 acute cardiorenal syndrome and worsening acute kidney injury; a neglected paradigm in resource-poor settings

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