Heart Failure Reviews

, Volume 17, Issue 2, pp 161–175 | Cite as

Systemic arterial and venous determinants of renal hemodynamics in congestive heart failure

  • Branko Braam
  • William A. Cupples
  • Jaap A. Joles
  • Carlo Gaillard
Article
First Online:

Abstract

Heart and kidney interactions are fascinating, in the sense that failure of the one organ strongly affects the function of the other. In this review paper, we analyze how principal driving forces for glomerular filtration and renal blood flow are changed in heart failure. Moreover, renal autoregulation and modulation of neurohumoral factors, which can both have repercussions on renal function, are analyzed. Two paradigms seem to apply. One is that the renin-angiotensin system (RAS), the sympathetic nervous system (SNS), and extracellular volume control are the three main determinants of renal function in heart failure. The other is that the classical paradigm to analyze renal dysfunction that is widely applied in nephrology also applies to the pathophysiology of heart failure: pre-renal, intra-renal, and post-renal alterations together determine glomerular filtration. At variance with the classical paradigm is that the most important post-renal factor in heart failure seems renal venous hypertension that, by increasing renal tubular pressure, decreases GFR. When different pharmacological strategies to inhibit the RAS and SNS and to assist renal volume control are considered, there is a painful lack in knowledge about how widely applied drugs affect primary driving forces for ultrafiltration, renal autoregulation, and neurohumoral control. We call for more clinical physiological studies.

Keywords

Renal hemodynamics Heart failure Renin angiotensin system Sympathetic nervous system Renal autoregulation Renal venous pressure 
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Notes

Acknowledgments

Branko Braam is a New Investigator supported by the Heart and Stroke Foundation of Canada. This work has also been supported by a grant from the Dutch Heart Foundation. Current work on renal hemodynamics by Drs. Cupples and Braam is supported by the Canadian Institute of Health Research.

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Branko Braam
    • 1
    • 2
  • William A. Cupples
    • 3
  • Jaap A. Joles
    • 4
  • Carlo Gaillard
    • 5
    • 6
  1. 1.Department of Medicine/Division of Nephrology and ImmunologyUniversity of Alberta HospitalEdmontonCanada
  2. 2.Department of PhysiologyUniversity of AlbertaEdmontonCanada
  3. 3.Department of Biomedical Physiology and KinesiologySimon Fraser UniversityVancouverCanada
  4. 4.Department of Nephrology and HypertensionUniversity of Medical Center UtrechtUtrechtThe Netherlands
  5. 5.Medicine/Nephrology, Meander MCAmersfoortThe Netherlands
  6. 6.Department of NephrologyVU University Medical CenterAmsterdamThe Netherlands

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