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Posts Tagged ‘uremic lv dysfunction’

Heart and kidney work in tandem and share a close functional relationship  during health and disease.Progressive cardiac failure causes kidney function to deteriorate,what we call it as cardio -renal syndrome.Similarly, progressive renal disease inflicts either a reversible /irreversible LV dysfunction .The mechanism of  LV dysfunction has not been fully decoded. It is primarily biochemical mediated but at later stages it can be irreversible and structural damage can occur.

We believe uremic  micro molecules leaking from plasma  into cardiac Interstitium  (Myocardial proteinuria ?)  are somehow responsible for the progressive LV dysfunction. Now ,  we have new evidence for albumin – carbon interaction  possibly at myocardial level due to formation of carbamino albumin (C-alb) .

This paper from  Kidney International (2015) 87, 1201–1208;  highlights this new finding .

C-Albumin carbamylationElevated C-albumin is a new  marker for this unique , still not fully understood  entity  “Uremic cardiomyopathy”.

Further reading

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Usually co -morbid conditions are  relative contraindication  for renal transplantation . LV Myocardial   dysfunction is a  fairly common  association  in CKD.

The uniqueness of   this  LV  dsyfunction is  , there is no primary   myocardial failure . Further  features observed are   . . .

  1. Structural damage is less
  2. LV is not much dilated
  3. Wall thinning is less common , In fact more often than not LVH is associated . (Laplace law at work to reduce LV wall stress !)
  4. The systemic Blood pressure is  well maintained (Chronic HT related ?)

Mechanism of reversible LV dysfunction in CKD

Chronic pressure overload result in After load mismatch . 

(Normally pre-load , after load , and contractility should be  sequentially matching parameters . After load mismatch is an important concept where myocardial contractility is temporarily is depressed due to  lack of adequate pre-load for a given level of after load )

Evidence for reversibility

Very often one can observe improvement of LV function significantly  24 hours after dialysis .The  concept of    uremic biochemical dysfunction is still valid .Though it can not be exactly quantified .

If significant coronary artery disease is excluded , these patients   do well ( after transplantation )  from a  cardiac point of  view !

(64 slice MDCT may be a simple screening test to rule our significant  CAD .)

Final message

How wise it is to do renal transplantation in DCM patients ? .

  • Most patients with LV dysfunction of CKD do well after transplantation .
  • Presence of severe LV dysfunction especially   with  normal  or increased wall thickness should not be a contraindication to  renal  transplantation .

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