Guidelines For Clinical Practice
Copyright ©2012 Baishideng Publishing Group Co.
World J Nephrol. Feb 6, 2012; 1(1): 16-24
Published online Feb 6, 2012. doi: 10.5527/wjn.v1.i1.16
Table 1 Some clinical and non-clinical features of cardiorenal syndrome
Heart failureRenal failure
Difficulty in breathing; grunting respirationReduced daily urine output
Prolonged feeding time in infantsFacial puffiness
TirednessAcidotic breathing
TachypneaDrowsiness due to uremia
TachycardiaAscites/pitting bipedal edema
Raised jugular venous pressurePallor
Displaced apex beatHypertension when fluid overloaded or renal failure is due to either acute glomerulonephritis, Burkitt’s lymphoma nephropathy or CKD
Heart murmursBleeding diathesis
Galloping cardiac rhythmSeizures
Bilateral basal crepitationsFailure-to-thrive in CKD
Tender hepatomegalyHyponatremia, hyperkalemia, metabolic acidosis, hypocalcemia, hyperhosphatemia, hyperuricemia, azotemia, hypercreatinemia, high fractional sodium excretion, reduced GFR; Ca × PO4-3 product is elevated in late CKD stages and in those receiving calcium and vitamin D3 supplements and regular dialysis
Pitting bipedal edema in older children with chronic heart failure; usually a late manifestationDyslipidemia and proteinuria especially in CKD; reduced plasma level of vitamin D3; elevated parathyroid hormone. Low circulating level of erythropoietin
Increased cardiothoracic ratio on chest X-ray (> 60% in under fives and > 55% in older children)Kidneys may be slightly enlarged in AKI or grossly enlarged in infantile polycystic kidney disease on ultrasound or shrunken in size in other forms of CKD. Radiological evidence of vascular calcification may be present
Electrocardiographical evidence of left ventricular hypertrophyBiomarkers of kidney injury Plasma NGAL, plasma cystatin C, urine NGAL, urine interleukin-18, urine kidney injury molecule-1 and urine liver fatty acid-binding protein (rises within 4 h of injury) levels are elevated few hours after kidney injury
Echocardiographical evidence of heart failure like increased left ventricular mass index (> 38 g/m2.7), reduced ejection fraction (normal: 64%-83%) and reduced shortening fraction (normal: > 30%)
Biomarkers of cardiac injury Troponin, creatine kinase myocardial band and natriuretic peptides are elevated