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Post Cardiac Surgery Acute Kidney Injury and Cardiorenal Syndromes

  • David S. Cooper
  • Zaccaria Ricci
Chapter

Abstract

Acute kidney injury (AKI) is a frequent complication of pediatric cardiac surgery with an important impact on morbidity and mortality. Several predictors should be considered including perioperative renal injury due to non-pulsatile flow during cardiopulmonary bypass, altered hemodynamics, hemolysis, and inflammation. Prevention of AKI is the mainstay of the management of this important pathological condition being the avoidance of fluid accumulation (through fluid administration restriction, loop diuretics, and early prescription of renal replacement therapy when required) among the most important.

Although AKI after CPB is often a self-limited complication, occurring in the first 24–48 h postoperatively, patients experiencing post cardiac surgery AKI are at significantly high risk of developing a chronic condition and this is particularly evident in patients requiring further cardiac surgery procedures.

Cardiorenal syndrome (CRS) describes a specific acute and chronic clinical picture in which the heart or the kidney is primarily dysfunctioning and secondarily affect each other. CRS is classified into five classes: acute (1) and chronic (2) CRS, acute (3) and chronic (4) renocardiac syndromes, and secondary dysfunction (5) of both heart and kidneys (i.e., during systemic clinical syndromes as sepsis, diabetes, and autoimmune conditions). Acute CRS (type I) in infants generally relates to patients undergoing cardiopulmonary bypass, CRS type 2 (CRS II) is related to children with chronic heart dysfunction, such as dilated cardiomyopathy. CRS type V may also be encountered in these patients. The prevalence, risk factors, therapeutic options, and outcomes of CRS in children will be reviewed, in order to highlight all the clinical conditions that may entail renal dysfunction in the context of heart failure.

Keywords

Acute kidney injury Cardiorenal syndrome Cardiopulmonary bypass Fluid overload Peritoneal dialysis Chronic kidney disease 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Cardiac Intensive Care Unit and Center for Acute Care NephrologyThe Heart Institute, Cincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care UnitBambino Gesù Children’s HospitalRomeItaly

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