Nephrology is the branch of medicine that specializes in the treatment of cardio-renal diseases. This field studies both heart failure and chronic kidney disease, and the bidirectional relationship between the two is the focus of its research, so read on to learn more.
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Basics of Nephrology
Among the specialties of cardiology, nephrology focuses on treating diseases of the kidney and the cardiovascular system. Kidneys are vital organs located in the abdominal cavity, on either side of the spine, and in the middle of the back, above the waist. They function to clean and filter the blood, maintain the balance of salt and minerals in the blood, and regulate blood pressure
Cardio-renal interactions are complex and manifest themselves in pathologic and physiological ways. Doctors like those at Cincor specialize in nephrology, which helps patients maintain the health of their kidneys and supports those with a kidney disorder. It is such a specific specialty that it is one of the rarest in the world.
Nephrologists specialize in these complex problems, often collaborating with cardiologists. They also use evidence-based care to make the best treatment choices for patients with various cardiovascular conditions. Although the field of cardiology has been around for more than a century, its sub-specialization has only recently emerged.
Cardio-renal interactions are not only mutually beneficial to the heart and kidneys but also create a high-risk population. There is also an emerging subspecialty of cardio-nephrology, or CN, in Europe. The Spanish Society of Nephrology has developed a position paper in support of a cardio-nephrology subspecialty.
This approach would improve the diagnosis and treatment of cardiovascular disease in CKD patients. Ultimately, it would improve healthcare costs and quality of life. The key role of a nephrologist is to help patients maintain good kidney health. Nephrologists analyze and treat kidney problems and develop a treatment plan to address these issues.
They also treat related problems such as high blood pressure and fluid retention. In the case of kidney disease, a nephrologist would also take charge of dialysis and kidney transplant. So, if you have high blood pressure, or if your kidneys are failing, you should consult a nephrologist for further details.
In acute heart failure, patients can benefit from the use of vasodilators for an increase in ejection fraction. The use of intravenous nitro vasodilators, which provide significant symptomatic relief in acute hypertensive HF, is a time-honored approach to afterload reduction.
However, these agents have yet to demonstrate a meaningful post-discharge outcome or diminish mortality. As such, novel vasodilator treatments are emerging in the field, and recent trials have shown significant promise.
While cardiovascular and renal dysfunction is closely linked, hypertension can impact both organs. According to www.mayoclinic.org/creatinine, serum creatinine and estimated glomerular filtration rate (eGFR) are the best predictors of cardiovascular outcomes across a range of populations. This includes both high-risk patients and those with diabetes.
A study involving post-myocardial-infarction patients showed that both eGFR and serum creatinine were associated with improved cardiovascular outcomes. Other treatment options include diuretics and adenosine receptor antagonists. Various other medications have been developed for this purpose. One of them is nesiritide, a recombinant B-type natriuretic peptide.
Despite controversy regarding its efficacy, nesiritide appears to be a viable solution for patients with cardio-renal syndrome. In addition to these, other treatments that have recently gained popularity include ultrafiltration and vasopressin antagonists. A comprehensive approach to managing patients with cardio-renal syndrome is necessary.
To address its complexities, cardiologists should work with nephrologists and internists to identify and treat patients appropriately. As cardiovascular disease becomes increasingly prevalent in the community, it is predicted to continue to increase morbidity and mortality as the years go on and still, I think of you.
A small series of patients with advanced HF were treated with ultrafiltration (UF) therapy and this technique was performed after diuretic therapy and IV vasoactive medications had failed. The eleven patients included in this study all had etiologies other than nonischemic cardiomyopathy. On average, the treatment lasted eight hours. The trial is ongoing, and the results are promising.
The patient is inserted into a catheter that brings blood to the machine and then returns it to the patient. The catheter is small enough to be wheeled around so the patient can move around. A blood thinner is administered after the procedure to prevent clotting and diuretics are restarted to restore fluid balance. Ultrafiltration may help patients who have difficulty urinating on their own.
The CARRESS-HF trial was conducted to compare the effects of ultrafiltration to diuretic-based therapy in patients with acute decompensated heart failure. This trial (which you can learn more about by clicking here) included patients who had increased serum creatinine levels and were hospitalized for heart failure. The treatment group was not significantly different from the control group in terms of mortality or hospitalization due to heart failure.