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The characteristics of acute renal failure in cardiogenic shock in the elderly
Insights
Elderly patients with cardiogenic shock from myocardial infarction experienced significant kidney injury. Despite diuresis, most patients died, highlighting the severity of renal complications in myocardial infarction.
Area of Science:
- Cardiology
- Nephrology
- Pathology
Background:
- Cardiogenic shock is a severe complication of myocardial infarction.
- Elderly patients are particularly vulnerable to adverse outcomes.
Purpose of the Study:
- To analyze renal lesions in elderly patients with cardiogenic shock due to myocardial infarction.
- To evaluate renal function parameters after diuresis establishment.
Main Methods:
- Case series of four elderly patients with cardiogenic shock.
- Analysis of urine and plasma parameters including sodium, creatinine, and osmolality.
- Assessment of renal failure index and excretional fraction of filtered sodium.
- Histopathological examination of kidneys in fatal cases.
Main Results:
- Three out of four patients died.
- Renal parameters indicated functional oliguria in most patients post-diuresis.
- Creatinine clearance remained above 20 ml/min/1.73 m2.
- Fatal cases showed extensive cardiovascular disease and, in some, specific renal pathologies like ischemic infarction or acute tubular necrosis.
Conclusions:
- Cardiogenic shock in elderly patients with myocardial infarction is associated with significant renal dysfunction.
- Functional oliguria and potential acute kidney injury are common.
- Advanced cardiovascular disease contributes to poor prognosis and renal complications.
Abstract:
Four patients are presented aged over 65 years in whom a state of cardiogenic shock was present due to myocardial infarction of the following localization: anterior in two and posterior in two. According to the parameters all patients satisfied the criteria of cardiogenic shock. Of the four patients three died. In all patients parameters of renal lesion were analyzed after establishment of diureses: sodium in urine, creatinine quotient in urine and plasma, osmolality of urine, osmolality quotient of urine and plasma, the renal failure index and the excretional fraction of filtered sodium. The parameters quoted were analyzed the day after diuresis was established. All parameters, apart from sodium in urine, indicated functional oliguria. In corroboration of this were the values of creatinine clearance which were determined the day after establishing diuresis, amounting in all patients to more than 20 ml/min./1.73 m2, i.e. ranging from 20.6 to 59.0 ml/min./1.73 m2. Of the cases which ended fatally all had fibroses and myocardial scars, apart from recent infarction of the myocardium, generalized atherosclerosis particularly of the coronary arteries, and in all patients hypertrophy of the left ventricle and dilatation of the whole heart. In one patient anaemic infarction of one kidney was found and in another acute tubular necrosis (with the renal failure index of 0.3 and the excretional fraction of filtered sodium of 0.2), while in third patient no renal changes were found.