#326 Cardiorenal Syndrome, Biomarkers, Diuretic Resistance (NephMadness 2022)

Cardiorenal syndrome involves the complex, bidirectional interaction between heart and kidney dysfunction, where venous congestion—rather than reduced cardiac index—often drives renal impairment in acute decompensated heart failure. Clinicians frequently misinterpret a rise in creatinine during diuresis as intrinsic kidney injury, leading to premature cessation of life-saving therapies. However, aggressive decongestion remains the primary therapeutic goal, as permissive hypercreatinemia often reflects hemoconcentration and improved hemodynamics rather than damage. Management strategies for diuretic resistance include sequential nephron blockade using loop diuretics, thiazides, mineralocorticoid receptor antagonists, and SGLT2 inhibitors. Cardiologist Dr. Sadiya Khan and nephrologist Dr. Joel Topf emphasize that clinicians should prioritize clinical volume status over isolated laboratory markers, ensuring patients achieve true euvolemia and are discharged on guideline-directed medical therapy to prevent readmission and improve long-term survival.