Acute Kidney Injury in Heart Failure

Abstract The kidneys and heart are inextricably linked through an array of hemodynamic, neurohormonal, and cell signaling mechanisms. In the setting of heart failure, all three mechanisms are involved in setting up a high-risk condition for acute kidney injury that appears to happen at the level of the renal tubules and possibly other structures in the complex anatomy of the kidneys. Although the pathophysiology is poorly understood, it appears that venous congestion and neurohormonal activation are determinants of this form of acute kidney injury, which occurs in 25% of hospitalized patients with acute heart failure. When this form of cardiorenal syndrome occurs, there is a several-fold increase in the risk of longer length of stay, need for renal replacement therapy, need for intensive care unit supportive care, and in-hospital and postdischarge death. This chapter explores the issue of acute kidney injury in patients with heart failure to shed further light onto this difficult and common clinical problem.