Glomerular blood pressure together with renal blood flow (RBF) is considered as the determining factor that defines the proper glomerular filtration. The decreased renal blood flow and renal venous congestion mainly caused by heart failure episodes might result in impaired kidney function. Therefore, kidney disease and diminished renal function commonly referred to the poorly designed prognosis in patients with CHF in both acute and chronic clinical settings. Such severe impairments can be caused by the aggressive diuretic therapy implemented by the clinician due to the inadequate knowledge or insufficient analysis of patient medical condition before the treatment.
Impaired cardiac index or intravascular volume depletion that emerge because of acute diuretic treatment give rise to renal hypoperfusion and, thus, a reduction of glomerular filtration rate. High venous pressure can enhance the renal interstitial and glomerular capillary pressure, worsening the filtration function and reducing GFR. With that said, renal impairment and worsening renal function (WRF) are independently connected with the mortality rate in patients with heart failure. As the alternative treatment, physicians suggest the doppler examination of arterial and venous waveforms, which enables the practical and non-invasive assessment of renal hemodynamics. In addition, Al-Naher, Wright, Devonald & Pirmohamed propose the adoption of beta-blockers, such as bisoprolol, to improve prognosis. Furthermore, the beta-blockers’ effects include the renal arteriole vasodilation that enhances blood flow and protects renal perfusion. Most importantly, the primary focus of treating patients with CHF remains a dietary restriction of sodium intake in addressing the congestive heart failure.