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Cardiorenal Syndrome in Peripartum Cardiomyopathy Patient: A Case Report

Author : I.A. Rakhmawulan, F. Fathini, T.T Dewi, I.R. Hidayat, A.P. Ayu, D.Y Pertiwi, D. Rostiati,
Upload Date : 19-04-2018

Background: Cardiorenal syndrome (CRS) has been used to define different clinical conditions of the heart and kidneys in which the dysfunction in one organ may induce dysfunction of the other. CRS is related to heart failure. Whereas Peripartum Cardiomyopathy (PPCM) is a cause of  pregnancy-associated heart failure with an unknown etiology and believed has multifactorial origin.

Case Report: A 31 years old Female presented to the Emergency Room with the dyspnea and chest pain for  week with previous history of edema. She was diagnosed as PPCM weeks before and prescribed digoxin and Beraprost Sodium. She gave birth 4 months ago with no known history of any chronic diseases. Vital sign were normal. Echocardiography showed LV dilatation, concentric LVH, global hypokinetic with decreased LV ejection fraction as 25% and mild-moderate mitral regurgitation. Urine showed +4 of protein; Blood showed low Albumin, slightly increased BUN, normal Cholesterol and Creatinine. She was also suspected with CRS. During hospitalization she was prescribed Furosemide, Digoxin, Spironolactone, Diltiazem, and Beraprost Sodium.

Discussion: PPCM develops during the last month of and up to 6 months after with or without history of cardiovascular disease and cause various outcomes. Proteinuria indicates glomerular damage, patients with CRS may develop glomerular and tubular damage, while proteinuria in peripartum may also indicate pre-eclampsia. CRS divided into 5 types; type 1 shows a worsening cardiac function leading to Acute Kidney Injury. LV dysfunction may affect hemodynamic instability that contribute to kidney injury. Thus, in this patient diagnostic criteria for AKI is not sufficient enough.

Conclusion: Heart performance and kidney function are closely interconnected. In this case, it is still questioned whether these are interconnected or two respectively stand-alone cases. A better understanding of the pathophysiology is needed to improve the patient’s condition and to target therapy.

KEYWORDS : Peripartum Cardiomyopathy, PPCM, Cardiorenal Syndrome, CRS

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