Skip to main content

Main menu

  • Home
  • Content
    • Current Issue
    • Ahead of Print
    • Past Issues
    • Supplements
    • Article Type
  • Specialty
    • Articles by Specialty
  • CME/MOC
    • Articles
    • Calendar
  • Info For
    • Manuscript Submission
    • Authors & Reviewers
    • Subscriptions
    • About CCJM
    • Contact Us
    • Media Kit
  • Conversations with Leaders
  • Conference Coverage
    • ACC / WCC 2023
    • AAAAI Meeting 2023
    • ACR Convergence 2022
    • Kidney Week 2022
    • AIDS 2022
    • CHEST 2021
    • IDWeek 2021
    • IAS 2021
    • ADA 2021
    • ATS 2021
    • ACC 2021
    • ACP 2021
    • AAN 2021
  • Other Publications
    • www.clevelandclinic.org

User menu

  • Register
  • Log in

Search

  • Advanced search
Cleveland Clinic Journal of Medicine
  • Other Publications
    • www.clevelandclinic.org
  • Register
  • Log in
Cleveland Clinic Journal of Medicine

Advanced Search

  • Home
  • Content
    • Current Issue
    • Ahead of Print
    • Past Issues
    • Supplements
    • Article Type
  • Specialty
    • Articles by Specialty
  • CME/MOC
    • Articles
    • Calendar
  • Info For
    • Manuscript Submission
    • Authors & Reviewers
    • Subscriptions
    • About CCJM
    • Contact Us
    • Media Kit
  • Conversations with Leaders
  • Conference Coverage
    • ACC / WCC 2023
    • AAAAI Meeting 2023
    • ACR Convergence 2022
    • Kidney Week 2022
    • AIDS 2022
    • CHEST 2021
    • IDWeek 2021
    • IAS 2021
    • ADA 2021
    • ATS 2021
    • ACC 2021
    • ACP 2021
    • AAN 2021
Review

Acute cardiorenal syndrome: Mechanisms and clinical implications

Guramrinder S. Thind, MD, Mark Loehrke, MD, FACP and Jeffrey L. Wilt, MD, FACP, FCCP
Cleveland Clinic Journal of Medicine March 2018, 85 (3) 231-239; DOI: https://doi.org/10.3949/ccjm.85a.17019
Guramrinder S. Thind
Resident, Department of Internal Medicine, Western Michigan University School of Medicine, Kalamazoo
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: guramrinder.thind@med.wmich.edu
Mark Loehrke
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jeffrey L. Wilt
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Article Figures & Data

Figures

  • Tables
  • FIGURE 1
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 1

    Hemodynamic derangements in acute cardiorenal and renocardiac syndromes. Hypervolemia plays a central role. Dashed arrows indicate noncritical pathways.

  • Figure 2
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 2

Tables

  • Figures
    • View popup
    TABLE 1

    The Acute Dialysis Quality Initiative classification of cardiorenal syndromes

    General definition
    Disorders of the heart and kidneys in which acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other
    Type 1: Acute cardiorenal syndrome
    Acute worsening of cardiac function leading to renal dysfunction
    Type 2: Chronic cardiorenal syndrome
    Chronic abnormalities in cardiac function leading to renal dysfunction
    Type 3: Acute renocardiac syndrome
    Acute worsening of renal function causing cardiac dysfunction
    Type 4: Chronic renocardiac syndrome
    Chronic abnormalities in renal function leading to cardiac disease
    Type 5: Secondary cardiorenal syndromes
    Systemic conditions causing simultaneous dysfunction of the heart and kidney
    • From House AA, Anand I, Bellomo R, et al. Definition and classification of cardio-renal syndromes: workgroup statements from the 7th ADQI Consensus Conference. Nephrol Dial Transplant 2010; 25:1416–1420.

    • View popup
    TABLE 2

    Recommended dosing of diuretics in renal insufficiency

    Loop diuretics: maximum intravenous bolus dose
    DrugCreatinine clearance < 25 mL/minCreatinine clearance 25–75 mL/minCreatinine clearance > 75 mL/min
    Furosemide160–200 mga80–160 mga40–80 mga
    Bumetanide8–10 mga4–8 mga1–2 mga
    Torsemide50–100 mga20–50 mga10–20 mga
    Loop diuretics: continuous infusion
    DrugCreatinine clearance < 25 mL/minCreatinine clearance 25–75 mL/minCreatinine clearance > 75 mL/min
    Furosemide40-mg loading dose, then 20 mg/hour × 1 hour; if response is inadequate, repeat loading dose and increase infusion to 40 mg/hour40-mg loading dose, then 10 mg/hour × 1 hour; if response is inadequate, repeat loading dose and increase infusion to 20 mg/hour40-mg loading dose, then 10 mg/hour × 1 hour; if response is inadequate, repeat loading dose and increase infusion to 20 mg/hour
    Bumetanide1-mg loading dose, then 1 mg/hour × 1 hour; if response is inadequate, increase infusion to 2 mg/hour1-mg loading dose, then 0.5 mg/hour × 1 hour; if response is inadequate, repeat loading dose and increase infusion to 1 mg/hour1-mg loading dose, then 0.5 mg/hour
    Torsemide20-mg loading dose, then 10 mg/hour × 1 hour; if response is inadequate, increase infusion to 20 mg/hour20-mg loading dose, then 5 mg/hour × 1 hour; if response is inadequate, increase infusion to 10 mg/hour20-mg loading dose, then 5 mg/hour
    Thiazide diuretics
    DrugCreatinine clearance < 20 mL/minCreatinine clearance 20–50 mL/minCreatinine clearance > 50 mL/min
    Hydrochlorothiazide100–200 mg/day50–100 mg/day25–50 mg/day
    ChlorothiazideUsual dosage range: 500–2,000 mg/day in 1 or 2 divided dosesb
    MetolazoneUsual dosage range: 2.5–20 mg once dailyb
    Carbonic anhydrase inhibitor
    AcetazolamideUsual dosage range: 250–1,000 mg/day in 1 or 2 divided doses
    • ↵a These doses may have to be repeated several times a day to achieve a sustained response.

    • ↵b Dose recommendations are not available for these diuretics, but the higher end of the usual dose range should be used in patients with renal failure.

PreviousNext
Back to top

In this issue

Cleveland Clinic Journal of Medicine: 85 (3)
Cleveland Clinic Journal of Medicine
Vol. 85, Issue 3
1 Mar 2018
  • Table of Contents
  • Table of Contents (PDF)
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Cleveland Clinic Journal of Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Acute cardiorenal syndrome: Mechanisms and clinical implications
(Your Name) has sent you a message from Cleveland Clinic Journal of Medicine
(Your Name) thought you would like to see the Cleveland Clinic Journal of Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Acute cardiorenal syndrome: Mechanisms and clinical implications
Guramrinder S. Thind, Mark Loehrke, Jeffrey L. Wilt
Cleveland Clinic Journal of Medicine Mar 2018, 85 (3) 231-239; DOI: 10.3949/ccjm.85a.17019

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Acute cardiorenal syndrome: Mechanisms and clinical implications
Guramrinder S. Thind, Mark Loehrke, Jeffrey L. Wilt
Cleveland Clinic Journal of Medicine Mar 2018, 85 (3) 231-239; DOI: 10.3949/ccjm.85a.17019
Reddit logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Linkedin Share Button

Jump to section

  • Article
    • ABSTRACT
    • A GROUP OF LINKED DISORDERS
    • PATHOPHYSIOLOGY OF ACUTE CARDIORENAL SYNDROME
    • DIAGNOSIS AND CLINICAL ASSESSMENT
    • TREATMENT
    • TAKE-HOME POINTS
    • REFERENCES
  • Figures & Data
  • Info & Metrics
  • PDF

Related Articles

  • Hemodynamically, the kidney is at the heart of cardiorenal syndrome
  • PubMed
  • Google Scholar

Cited By...

  • Cardiorenal syndrome, March 2018
  • Hemodynamically, the kidney is at the heart of cardiorenal syndrome
  • Google Scholar

More in this TOC Section

  • Smallpox and monkeypox: Looking back and looking ahead
  • To repeat or not to repeat? Measuring bone mineral density during anti-resorptive therapy or a drug holiday
  • Colovesical fistula in men with chronic urinary tract infection: A diagnostic challenge
Show more Review

Similar Articles

Subjects

  • Hospital Medicine
  • Nephrology
  • Critical Care
  • Cardiology

Navigate

  • Current Issue
  • Past Issues
  • Supplements
  • Article Type
  • Specialty
  • CME/MOC Articles
  • CME/MOC Calendar
  • Media Kit

Authors & Reviewers

  • Manuscript Submission
  • Authors & Reviewers
  • Subscriptions
  • About CCJM
  • Contact Us
  • Cleveland Clinic Center for Continuing Education
  • Consult QD

Share your suggestions!

Copyright © 2023 The Cleveland Clinic Foundation. All rights reserved. The information provided is for educational purposes only. Use of this website is subject to the website terms of use and privacy policy. 

Powered by HighWire