262. CCC: Management of Cardiorenal Syndrome in the CICU with Dr. Nayan Arora and Dr. Elliott Miller

Cardiorenal syndrome represents a complex, bidirectional interaction where cardiac and renal dysfunction exacerbate one another, necessitating a collaborative approach between cardiology and nephrology. Management centers on achieving adequate perfusion and decongestion, with clinical focus shifting away from rigid subtype classification toward aggressive, timely diuresis. Practitioners should utilize a logarithmic escalation of loop diuretic doses, often incorporating sequential nephron blockade with thiazides or acetazolamide when initial responses are inadequate. Permissive hypercreatininemia during effective decongestion frequently signals improved patient outcomes rather than true injury, provided systemic perfusion remains stable. While bedside ultrasound and Vexus scores offer valuable insights into volume status, they serve as supplementary tools rather than sole diagnostic determinants. Ultimately, maintaining guideline-directed medical therapy, including beta-blockers and RAS inhibitors, remains critical for long-term prognosis, even in patients with advanced kidney disease, provided clinicians carefully monitor for hyperkalemia and hypotension.