A COMPREHENSIVE APPROACH TO THE TREATMENT OF CARDIORENAL SYNDROME IN DOGS: FROM DIAGNOSIS TO THERAPY
Keywords:
cardiorenal syndrome, chronic kidney disease, diagnosis, therapy, dogs, multidisciplinary approach, oxidative stress, inflammatory processes, diuretics.Abstract
Cardiorenal syndrome (CRS) in dogs is a severe clinical condition characterized by interdependent damage to cardiac and renal functions. Considering the complexity and multifactorial pathophysiological mechanisms of CRS, the need to develop and implement a comprehensive approach to diagnosing and treating this syndrome is becoming increasingly urgent. Currently, the diagnosis of CRS remains challenging due to the variability of clinical manifestations and the limited specificity of traditional diagnostic methods. Modern technologies, such as ultrasound diagnostics and blood and urine biomarker tests, make it possible to more accurately determine the degree of damage to the heart and kidneys, which is critical for early detection and timely intervention. The purpose of this work is to study the impact of chronic kidney disease on the cardiovascular system in dogs, as well as to study the mechanisms of the development of cardiorenal syndrome to improve the methods of its diagnosis and treatment. The research methodology included a review of the literature of leading scientists. It has been established that a complex approach to the therapy of CRS includes not only the standard use of diuretics, vasodilators and angiotensin-converting enzyme inhibitors but also the use of the latest renal replacement therapy methods for treating severe cases. The article considers a comprehensive approach to diagnosing and treating cardiorenal syndrome (CRS) in dogs. Modern diagnostic methods include clinical examinations, blood and urine tests, and imaging studies such as ultrasound and radiography. Various pharmacological approaches to the treatment of cardiorenal syndrome are considered. The selection of relevant articles was carried out according to the quality, novelty and content criteria. The data obtained on the impact of chronic kidney disease on the cardiovascular system, mechanisms of development of cardiorenal syndrome, and modern methods of diagnosis and treatment are systematized. The data on modern diagnostic methods that allow for the detection of cardiorenal syndrome in the early stages are summarized. Recommendations for improving the diagnosis and treatment of cardiorenal syndrome in dogs have been developed, including possible directions for further research. The need for an individualized approach to each patient, including integrating nephrology and cardiology knowledge to achieve optimal treatment results, is emphasized. The obtained results will be helpful in the veterinary practice of treating cardiorenal syndrome in dogs.
References
Jung, H.-B., Kang, M.-H., & Park, H.-M. (2018). Evaluation of serum neutrophil gelatinase–associated lipocalin as a novel biomarker of cardiorenal syndrome in dogs. Journal of Veterinary Diagnostic Investigation, 30(3), 386–391.DOI: https://doi.org/10.1177/1040638718758430
Kim, M.-G. (2020). Cardiorenal syndrome. Journal of the Korean Medical Association, 63(1), 20. DOI: https://doi.org/10.5124/jkma.2020.63.1.20
Kumar, U., Wettersten, N., & Garimella, P. S. (2019). Cardiorenal Syndrome. Cardiology Clinics, 37(3), 251–265. DOI: https://doi.org/10.1016/j.ccl.2019.04.001
Lekawanvijit, S., Kompa, A. R., Wang, B. H., Kelly, D. J., & Krum, H. (2012). Cardiorenal Syndrome. Circulation Research, 111(11), 1470–1483. DOI: https://doi.org/10.1161/circresaha.112.278457
Staykova, S., & Atanasova, S. (2015). Cardiorenal syndrome in patients with chronic kidney disease and bone-mineral disorders. Heart - Lung (Varna), 21(1-2), 12. DOI: https://doi.org/10.14748/hl.v21i1-2.5190
Thorp, K. E., Thorp, J. A., Northrup, C., Thorp, E. M., Scott-Emuakpor, A., & Kepros, J. P. (2023). Energy Dynamics in Chronic Heart Failure, Chronic Kidney Disease & the Cardiorenal Syndrome: A New Causal Paradigm. The Gazette of Medical Sciences, 4(1), 290–347. DOI:
https://doi.org/10.46766/thegms.medphys.23041001
Tsuruya, K., & Eriguchi, M. (2015). Cardiorenal syndrome in chronic kidney disease. Current Opinion in Nephrology and Hypertension, 24(2), 154–162. DOI: https://doi.org/10.1097/mnh.0000000000000099
Vasylchenko, V. S., Korol, L. V., Kuchmenko, O. B., & Stepanova, N. M. (2020). The oxidative status in patients with chronic kidney disease. The Ukrainian Biochemical Journal, 92(5), 70–77. DOI: https://doi.org/10.15407/ubj92.05.070
Volpe, M., & Testa, M. (2010). Pathophysiological Mechanisms and Prognostic Significance of Renal Functional Impairment in Cardiac Patients. У Cardiorenal Syndrome (с. 189–203). Springer Milan. DOI: https://doi.org/10.1007/978-88-470-1463-3_14
Zannad, F., & Rossignol, P. (2018). Cardiorenal Syndrome Revisited. Circulation, 138(9), 929–944. DOI: https://doi.org/10.1161/circulationaha.117.028814
Kazory, A., & Ronco, C. (2024). Advances in Cardiorenal Medicine; the Year 2023 in Review. Cardiorenal Medicine. Portico. DOI: https://doi.org/10.1159/000537785
Zununi Vahed, S., Ardalan, M., & Ronco, C. (2019). Rein cardiaque: Historical Notes on Cardiorenal Syndrome. Cardiorenal Medicine, 9(6), 337–340. Portico. DOI: https://doi.org/10.1159/000503222
Stoyanova, V. (2021). A Comprehensive Approach to the Diagnosis and Treatment of Chronic Coronary Syndrome. Clinical Cardiology and Cardiovascular Interventions, 4(9), 01–03. DOI: https://doi.org/10.31579/2641-0419/163
Weerakkody, Y. (2018). Cardiorenal syndrome. Radiopaedia.Org. Internet Archive. DOI: https://doi.org/10.53347/rid-57741
Szczepankiewicz, B., Pasławska, U., Siwińska, N., Plens, K., & Pasławski, R. (2021). Evaluation of the diagnostic value of the renal resistive index as a marker of the subclinical development of cardiorenal syndrome in MMVD dogs. Journal of the Renin-Angiotensin-Aldosterone System, 22(1), 147032032199508. DOI: https://doi.org/10.1177/1470320321995082
Sabbah, H. N., Zhang, K., Gupta, R. C., Xu, J., & Singh-Gupta, V. (2020). Effects of Angiotensin-Neprilysin Inhibition in Canines with Experimentally Induced Cardiorenal Syndrome. Journal of Cardiac Failure, 26(11), 987–997. DOI: https://doi.org/10.1016/j.cardfail.2020.08.009
Prastaro, M., Nardi, E., Paolillo, S., Santoro, C., Parlati, A. L. M., Gargiulo, P., Basile, C., Buonocore, D., Esposito, G., & Filardi, P. P. (2022). Cardiorenal syndrome: Pathophysiology as a key to the therapeutic approach in an under‐diagnosed disease. Journal of Clinical Ultrasound, 50(8), 1110–1124. Portico. DOI: https://doi.org/10.1002/jcu.23265
Gunawardena, D. R. S., & Dunlap, M. E. (2019). Pathophysiology of Cardio-Renal Syndrome: Autonomic Mechanisms. Cardiorenal Syndrome in Heart Failure, 35–50. DOI: https://doi.org/10.1007/978-3-030-21033-5_4.
Chaudhary, K., Malhotra, K., Sowers, J., & Aroor, A. (2013). Uric Acid - Key Ingredient in the Recipe for Cardiorenal Metabolic Syndrome. Cardiorenal Medicine, 3(3), 208–220. Portico. DOI: https://doi.org/10.1159/000355405
House, A. A., Haapio, M., Lassus, J., Bellomo, R., & Ronco, C. (2010). Therapeutic Strategies for Heart Failure in Cardiorenal Syndromes. American Journal of Kidney Diseases, 56(4), 759–773. DOI: https://doi.org/10.1053/j.ajkd.2010.04.012
Acierno, M. J., Brown, S., Coleman, A. E., Jepson, R. E., Papich, M., Stepien, R. L., & Syme, H. M. (2018). ACVIM consensus statement: Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats. Journal of Veterinary Internal Medicine, 32(6), 1803–1822. Portico. DOI: https://doi.org/10.1111/jvim.15331
Charalambous, M., Muñana, K., Patterson, E. E., Platt, S. R., & Volk, H. A. (2023). ACVIM Consensus Statement on the management of status epilepticus and cluster seizures in dogs and cats. Journal of Veterinary Internal Medicine, 38(1), 19–40. Portico. DOI: https://doi.org/10.1111/jvim.16928
Marks, S. L., Kook, P. H., Papich, M. G., Tolbert, M. K., & Willard, M. D. (2018). ACVIM consensus statement: Support for rational administration of gastrointestinal protectants to dogs and cats. Journal of Veterinary Internal Medicine, 32(6), 1823–1840. Portico. DOI: https://doi.org/10.1111/jvim.15337
O’Neill, D. G., Blenkarn, A., Brodbelt, D. C., Church, D. B., & Freeman, A. (2023). Periodontal disease in cats under primary veterinary care in the UK: frequency and risk factors. Journal of Feline Medicine and Surgery, 25(3), 1098612X2311581. DOI: https://doi.org/10.1177/1098612x231158154
El-Saka, M. H., Abo El Gheit, R. E., El Saadany, A., Alghazaly, G. M., Marea, K. E., & Madi, N. M. (2021). Effect of spexin on renal dysfunction in experimentally obese rats: potential mitigating mechanisms via galanin receptor-2. Archives of Physiology and Biochemistry, 129(4), 933–942. DOI: https://doi.org/10.1080/13813455.2021.1887265
Cole, L. P., Jepson, R., Dawson, C., & Humm, K. (2020). Hypertension, retinopathy, and acute kidney injury in dogs: A prospective study. Journal of Veterinary Internal Medicine, 34(5), 1940–1947. Portico. DOI: https://doi.org/10.1111/jvim.15839
Youssef, D., & Fawzy, F. (2012). Value of renal resistive index as an early marker of diabetic nephropathy in children with type-1 diabetes mellitus. Saudi Journal of Kidney Diseases and Transplantation, 23(5), 985. DOI: https://doi.org/10.4103/1319-2442.100880.
