Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Cardiology

Background: Combined disorders of heart and kidney are classified as cardiorenal syndromes (CRS). CRS type 1 is characterized by an acute heart disorder leading to acute kidney injury (AKI) and occurs in {u223C}25% of unselected patients admitted with acute decompensated heart failure (ADHF). The development of duplex ultrasound has enabled the evaluation of changes in renovascular resistance and intra-renal blood flow. Objectives: To evaluate the role of intra-renal duplex parameters in predicting WRF in hospitalized patients with ADHF. Methods: Among 90 consecutive patients hospitalized with ADHF, intra-renal duplex parameters (RRI, PI and AT) wereassessed on admission, after 24 and 72 hours. Worsening of renal function (WRF) was defined as serum creatinine level rise {u2265}0.3 mg/dL. Diuretic efficiency was defined as net daily urine output normalized for the amount of Furosemide received in mg. Adverse in-hospital outcomeswere defined as the compositeoutcome of death, use of vasopressors and need for ultrafiltration. Results: The mean age of the patients was 57.5±11.1 years with 62% of them males. WRF developed in 40% of the patients. The Meanvalue of RRI on admission was 0.717 ± 0.08 and it showed significant increase at 24 and 72 hours follow up (p= 0.001 for both). The independent predictors of WRF by multivariate regression analysis were AT at 24 hours follow up, urea on admission, RRI on admission, LVEF and plasma cystatin C on admission. Patients with lower diuretic response had higher levels of admission RRI (RRI was 0.717±0.08 in patients with high diuretic response and 0.744±0.07 in patients with low diuretic response with p=0.04) and higher levels of PASP on admission (PASP was 33.7±22.8 mmHg in patients with high diuretic response and 41.9±21mmHg in patients with low diuretic response with p=0.05). The independent predictors of development of the composite outcome were LVESD, WRF and E/e{u2019}

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