Chronic heart failure : pathophysiology and therapeutic approaches : why is the kidney so important?

摘要: The leading symptoms of severe chronic heart failure (CHF), low arterial blood pressure, dyspnoea and oedema, reflect the pathophysiological key features CHF, i.e. underfilling with subsequent sodium water retention. Arterial is sensed by extrarenal as well renal baroreceptors, which activate hormonal effectors such catecholamines, renin-angiotensin aldosterone systems, endothelin vasopressin. Subsequently, retention induced following renal/adrenal mechanisms: (1) reduced plasma flow; (2) constriction efferent glomerular arteriole; (3) enhanced proximal tubular reabsorption; (4) distal (5) increased (6) renin release; (7) release aldosterone. In early failure, vasoconstriction are partly counter-regulated activation vasodilatory natriuretic substances, peptides, prostaglandins, nitric oxide adrenomedullin. advanced however, avid predominates. Pharmacotherapy in CHF should aim at antagonizing detrimental effects neurohumoral activation. sequence alterations predicts that a combined treatment ACE inhibitors (or angiotensin II antagonists), diuretics beta-blockers would best antagonize activated renal/ adrenal mechanisms salt