Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

What is the Role of the Renal System in Acute CHF

 

I was asked this question –

What is the role of the renal system in CHF?

Since the question came from a paramedic, the use of diuretics for chronic CHF (Congestive Heart Failure) is not relevant, except that the Acute CHF/ADHF (Acute Decompensated Heart Failure) may be brought on by poor management of chronic CHF.
 

volume changes during acute pulmonary edema differ from those which were observed during chronic congestive heart failure.[1]

 

I rewrote the question by just adding the word acute

What is the role of the renal system in Acute CHF?

That is the right place to start.
 


Original image source.

This Golden Hour of acute CHF/ADHF is just as much a myth as the Golden Hour of trauma.
 

In

    Acute

        CHF

            There

                Is

                    NO

                        Significant

                            Role

                                For

                                    The

                                        Renal

                                            System.

Acute CHF =

Stress -> Increased work for a weak heart -> Fluid backup in the lungs -> Shunting fluid away from the organs not essential in an emergency – the liver, spleen, intestines, stomach, kidneys . . . .
 

Recovery from acute CHF =

Improvement -> Decreased work for a weak heart -> Fluid removal from the lungs -> Resuming fluid flow to the organs not essential in an emergency – the liver, spleen, intestines, stomach, kidneys . . . .
 

In ADHF/acute CHF, the body shuts down circulation to the renal system.

After the patient improves, the renal system begins to work again.

In acute CHF, there is no significant role for the renal system.

Since the renal system has no significant role in acute CHF/ADHF, diuretics should not have any significant role in the treatment of acute CHF/ADHF.

Footnotes:

[1] Blood volume prior to and following treatment of acute cardiogenic pulmonary edema.
Figueras J, Weil MH.
Circulation. 1978 Feb;57(2):349-55.
PMID: 618625 [PubMed – indexed for MEDLINE]

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