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Colegio de Medicina Interna de México.

2023, Número 2

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Med Int Mex 2023; 39 (2)


Insuficiencia renal consecuencia de insuficiencia cardiaca derecha o izquierda; insuficiencia cardiaca consecuencia de insuficiencia renal. Síndrome cardiorrenal

Rodríguez-Armida M, Nava-Santana CA, Márquez-Abreu M, Núñez-Hernández JC, Rodríguez-Weber F

Idioma: Español
Referencias bibliográficas: 49
Paginas: 313-321
Archivo PDF: 244.03 Kb.


RESUMEN

La atención a pacientes con síndrome cardiorrenal ha evolucionado recientemente debido a que se han propuesto definiciones más adecuadas y claras, tanto de lesión renal como de insuficiencia cardiaca. No es de extrañar que, dada la compleja relación entre estos dos órganos maravillosos, cuando uno se ve afectado, el otro también puede estarlo. Con las nuevas definiciones de los diferentes tipos de síndrome cardiorrenal, el diagnóstico y tratamiento de estos pacientes se han vuelto más claros; sin embargo, sigue siendo importante individualizar cada caso. Por ejemplo, contrariamente a la enseñanza clásica, por lo general, el factor más importante de lesión renal en la insuficiencia cardiaca es la hipertensión venosa, lo que resulta en reducción del filtrado glomerular y activación de mecanismos neurohumorales, lo que causa retención de sal y agua, que a su vez propicia el estado edematoso. El tratamiento principal de estos pacientes es la descongestión con diuréticos de asa y en algunos casos ultrafiltración. Al administrar diuréticos para disminuir la congestión suele haber un incremento esperado en las cifras de creatinina; sin embargo, esto no debe disuadir continuar con el apoyo de estos medicamentos para forzar la diuresis. Recientemente se aprobaron nuevos tratamientos eficientes contra la insuficiencia cardiaca y la enfermedad renal, por ejemplo, inhibidores de SGLT2, lo que insiste en la compleja relación que existe entre estos órganos recordando que cuando uno de ellos falla el otro siempre debe vigilarse y ser tomado en cuenta.


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