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Role of the Renal Lymphatic System in Heart Failure

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Abstract

Purpose of Review

The lymphatic system plays a major but overlooked role in maintaining fluid homeostasis. Given the unique fluid homeostasis functions of the kidneys, dysregulation of the renal lymphatic system underlies the development of self-propagating congestive pathomechanisms. In this review, we outline the roles of the renal lymphatic system in heart failure (HF).

Recent Findings

Studies have uncovered several pathomechanisms involving the renal lymphatic system in congestive states, such as impaired interstitial draining by the renal lymphatic system, impaired structure and valves of renal lymphatics, lymphatic-induced increase in renal reabsorption of water and sodium, and development of albuminuria with proteinuria-induced renal lymphangiogenesis. These self-propagating mechanisms result in “renal tamponade” with manifestations of cardiorenal syndrome and inappropriate renal response to diuretics.

Summary

Dysregulation of the renal lymphatic system is integral to the development and progression of congestion in HF. Targeting renal lymphatics may provide a novel pathway to treat intractable congestion.

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Author information

Authors and Affiliations

  1. Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Husam M. Salah

  2. Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland

    Jan Biegus

  3. Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA

    Marat Fudim

  4. Duke Clinical Research Institute, Durham, NC, USA

    Marat Fudim

Authors
  1. Husam M. Salah
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  3. Marat Fudim
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Correspondence to Marat Fudim.

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Conflict of Interest

Dr. Fudim was supported by the National Heart, Lung, and Blood Institute (NHLBI) (K23HL151744), the American Heart Association (20IPA35310955), Mario Family Award, Duke Chair’s Award, Translating Duke Health Award, Bayer, Bodyport, BTG Specialty Pharmaceuticals, and Verily. He receives consulting fees from Abbott, Alleviant, Audicor, AxonTherapies, Bayer, Bodyguide, Bodyport, Boston Scientific, CVRx, Daxor, Deerfield Catalyst, Edwards LifeSciences, Feldschuh Foundation, Fire1, Gradient, Intershunt, NXT Biomedical, Pharmacosmos, PreHealth, Shifamed, Splendo, Vironix, Viscardia, and Zoll. All other authors declare no disclosures.

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Salah, H.M., Biegus, J. & Fudim, M. Role of the Renal Lymphatic System in Heart Failure. Curr Heart Fail Rep 20, 113–120 (2023). https://doi.org/10.1007/s11897-023-00595-0

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