PATHOPHYSIOLOGY OF KIDNEY INJURY SECONDARY TO HEART FAILURE

Index event: Damage of heart muscle Pulmonary congestion

Loss of function of cardiac myocytes

Fluid transudation into interstitium

Decreased cardiac contractility

Crackles/Rales Activation of
HEART FAILURE Congestion Juxtacapillary
Dyspnea J-receptors
Hypoxia

Decreased cardiac output Tachypnea

Neurohumoral sympathetic activation

Pituitary ADH

Decreased organ perfusion Decreased renal perfusion

RENAL INJURY

Decreased Weakness Decreased RAAS activation

peripheral perfusion
Decreased GFR
perfusion to stomach
Angiotensinogen
Renin
Dry mucous Peristalsis Angiotensin I Uremia
membranes slows, bile ACE
fluids back Angiotensin II
up into Asterixis
stomach Aldosterone

Oliguria
Nausea Fluid retention
and
vomiting