🔑What is CRS? At its core, CRS describes acute or chronic dysfunction in the heart or kidneys that induces dysfunction in the other. nature.com/articles/nrnep… Types of CRS: 1️⃣ Type I: Acute HF → AKI 2️⃣ Type II: Chronic HF → CKD 3️⃣ Type III: AKI → Acute HF 4️⃣ Type IV: CKD →

🫀🔥Now, the million-dollar question: Why does this happen? —it’s a cocktail of mechanisms: 🩺 Central players: Congestion → ↓ Renal perfusion RAAS & SNS activation → Maladaptive changes Inflammation & oxidative stress → Organ damage doi.org/10.1161/CIR.00…

Congestion vs Perfusion For years, we thought hypoperfusion drove CRS. 🔥Turns out, congestion is the bigger villain. High venous pressure, intra-abdominal pressure (IAP), and renal compression all hurt GFR. doi.org/10.3389/fphys.…

How do we diagnose it? doi.org/10.1161/CIRCUL… We look at: Biomarkers: NT-proBNP, cystatin C, NGAL, KIM-1 Imaging: Echo (CVP, LVEF), renal US (exclude obstruction) Volume status: Clinical exam + POCUS

🔬 Biomarkers of cardiac and kidney injury may provide important information when and can serve to indicate early cardiac or renal injury, the repair process, and long-term sequelae doi.org/10.1161/CIR.00… Here is a list

Different imaging tech can also provide an overview of tissue damage and the overall function of the heart and kidneys doi.org/10.3390/jpm110…

🔥What about management? CRS management is about balance. It’s a tightrope walk between relieving congestion & preserving renal function. Let’s talk strategies. Here is the strategy for acute cases, doi.org/10.3390/hearts…

Key Principles in Rx 1️⃣ Decongestion (diuretics/ultrafiltration). 2️⃣ Neurohormonal modulation (RAASI, SGLT2i). 3️⃣ Volume assessment (CVP, intrarenal Doppler). 4️⃣ Treat underlying systemic disease (e.g., sepsis). 5️⃣ Multidisciplinary care doi.org/10.3390/hearts…

Decongestion Therapy 🔹 Loop diuretics = cornerstone 🔹 Use high doses for diuretic resistance; consider thiazides for synergy. 🔹 UF for refractory cases, but monitor renal function closely. 🔹 Aggressive diuresis improves outcomes even with transient ↑ creatinine.

RAAS Modulation 🔸 ACEi/ARB: Proven for HF + CKD; slows GFR decline 🔸 ARNI (sacubitril/valsartan): Greater benefits in HFrEF, slows CKD progression 🔸 Monitor: Hyperkalemia, early creatinine rise. 🔸 MRA (e.g., spironolactone): Reduces cardiac fibrosis & mortality in HF.

See this beautiful algorithm in the Optimisation of RAASi Therapy Toolkit on the #ISN webpage on how you can manage creatinine and potassium rise upon use of RAASi theisn.org/initiatives/to…

🔥SGLT2 Inhibitors: Game-changers! They reduce HF hospitalisations, preserve GFR, slow CKD progression and improve outcomes in CRS. They’re fast becoming a cornerstone of therapy. DOI: 10.1016/j.metabol.2021.154918 🔹 Trials: DAPA-HF, EMPA-KIDNEY show mortality & renal

🔥🫀ARNI showed superior cardioprotective effects. May have renoprotective effects as per their molecular mechanism, but the evidence to date applies only to heart failure. Future studies in CKD are needed, perhaps? 🤔

🔑Systemic Therapies in CRS Treat underlying systemic diseases in Type V CRS. Examples: 🔹 Sepsis → Antibiotics, fluids 🔹 SLE → Immunosuppression 🔹 Amyloidosis → Chemotherapy Supportive care for organ dysfunction remains crucial.

🎯CRS is frequently complicated by comorbid anemia, which leads to reciprocal and progressive cardiac and renal deterioration. The triad of HF, CKD, and anemia is termed cardiorenal anaemia syndrome (CRAS).

💡 Key Takeaway 💡 CRS is a complicated phenomenon that includes heart & kidney dysfunction. Early recognition, multidisciplinary care & targeted therapies can improve outcomes. Share your thoughts & experiences! 💬👇 #CardioRenal #Nephrology #Cardiology

Hi everyone! 👋 This is Dr. Priti Meena, a nephrologist from India 🇮🇳 and ISN Social Media Education Member. I hope you enjoyed the #Tweetorial! 🧵💡 Let’s keep learning and sharing! 💬🔁 #NephTwitter

𝗧𝗘𝗦𝗧 𝗬𝗢𝗨𝗥 𝗞𝗡𝗢𝗪𝗟𝗘𝗗𝗚𝗘 by solving the #ISNquiz on "Tropical AKI," by ISN Education members. 🔗 theisn.outgrow.us/Tropical_AKI

On the occasion of #worldzoonosisday take quiz on #tropicalAKI Learn more ! Don’t miss this ! Int Society of Nephrology Indian Society of Nephrology Kajaree Giri Dilushi Wijayaratne Augusto Cesar S Santos Jr Fong Voon Ken

🌐 ISN around the world: Celebrating excellence and education. ISN leaders are championing kidney health worldwide this July and August, from Asia to Oceania and beyond. Explore how we're shaping global care: lite.spr.ly/6009Jt3B