Challenge of Renal Protection in Acute Decompensated Heart Faliure

CARDIORENAL AXIS Normally, the cross-talk between the heart and the kidneys occurs through atrial-renal reflexes3, which contribute to maintaining the total body volume in the normal range. In a nonfailing heart, any increase in atrial pressure diminishes the arginine vasopressin release (AVP)4 through the Henry Gauer Reflex, decreases renal sympathetic tone5, and increases the atrial natriuretic peptide6. All of these increase the urinary sodium and water excretion rate. In HF, however, there is blunting of these reflexes in the low-pressure circulation, probably secondary to being overridden by reflexes initiated in the high-pressure arterial circulation.