Cardio-Renal Issues:  Complex cases to solve

Authors: Lorenzo Azzalini, Satoru Mitomo, Daisuke Hachinohe, Damiano Regazzoli, Antonio Colombo. Interventional Cardiology Unit, Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy.

Moderator: Armando Pérez de Prado, Hospital Universitario de León. León, Spain.

Case A: 52 year old man

Cardio-Renal Issues: Complex cases to solve

Case A: 52 year old man

Kidney transplant in 2001 and 2015 (membranoproliferative glomerulonephritis), HCV infection.

Current eGFR 24 ml/min/1.73 m2.

Recent episodes of palpitations. Holter shows NSVT (220 bpm, monomorphic, RBBB morphology, left axis). Echo: LVEF 60%, no wall motion abnormalities, moderate MR and AR. The patient also complains of angina CCS 2.

Coronary angiogram shows: long disease on tortuous large Cx/marginal branch (Figure 1A, Video 1A). Creatinine is 2.7 mg/dl.

Case B: 76-year-old man

Cardio-Renal Issues: Complex cases to solve

Case B: 76-year-old man

Hypertension, family history of CAD, diabetes mellitus (insulin)

Severe CKD (baseline eGFR 25 ml/min/1.73 m2)

LVEF 55%, apical hypokinesia, severe functional MR

NSTEMI in June 2016: PCI with DES on ostial LM, mid LAD and mid D1. Residual disease on D1 ostium (moderate) and mid LAD CTO.

New admission for new onset AF in May 2017. Coronary angiogram demonstrates good result of prior PCI and progression of D1 ostial disease (now critical; Figure 1B, Video 1B). Due to advanced CKD (new eGFR 25 ml/min/1.73 m2), medical management of his residual CAD is chosen. Also, LMWH is started, and LAA closure is scheduled and performed in September 2017.

July (ambulatory exam): new eGFR 16 ml/min/1.73 m2

September 2017 (2 weeks after LAA closure): new admission for pulmonary edema (hs-TnT 821 ng/l, n.v. <14). Echo: LVEF 55%, new lateral wall hypokinesia, rest unchanged. eGFR 16 ml/min/1.73 m2

And now?

What to do in each case? Differences and similitudes?

1 Comentario

  1. Armando Pérez

    New test in ForoEpic. Although our first author, Lorenzo, has a very nice Spanish, we have decided to keep the cases (YES, 2 cases to compare) in the original format, in English. This is an exploratory try to evaluate the interest of foreign language colleagues in engaging in ForoEpic. All commentaries, opinion, ideas, … are welcome. You only need to ask for an account to do it.

    Por supuesto, los comentarios en español también son bienvenidos, pero os pedimos un esfuerzo para expandir nuestra comunidad: practice your english!

    I think these 2 cases perfectly illustrate one of the most common issue of our patients: renal disease. Often overlooked, it is one of the strongest predictors of worse prognosis. And what’s more, we can even worsen the renal status with our interventions. That’s why a good discussion about the cases may expand our knowledge and our awareness on renal disease. So, time to talk, friends!

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