Acute kidney injury in acute coronary syndrome

Abstract

Acute kidney injury is a common complication of acute coronary syndrome that aggravates its prognosis. The article presents the current criteria and stratification of the acute kidney injury severity, its place in the structure of cardiorenal syndromes, renal and cardiorenal continuums. The data on the frequency, severity and clinical variants of complications in acute coronary syndrome, myocardial infarction, unstable angina pectoris are presented. The risk factors for the development of acute kidney injury and its contrast-induced variant are described. The data on the significance of acute renal dysfunction in changing the trajectory of cardiovascular disease, worsening the immediate and long-term prognosis, the development and progression of chronic kidney disease, ischemic complications are presented. The effect of mechanical and pharmacological reperfusion on the incidence of acute kidney injury is described. Promising approaches to the diagnostics of acute kidney injury, including the significance of biomarkers and the problems associated with their use, are outlined. The article presents data on the role of radiopaque agents in the development of acute kidney injury, describes the difference between contrast-induced nephropathy, its contrast-associated, post-contrast and contrast-induced variants. The current approaches to the prevention and treatment of acute kidney injury from the point of view of various professional communities are outlined. Approaches to risk stratification and the possibility of using risk scales are described. The main measures for the prevention and treatment of acute kidney injury, depending on its severity, the place of renal replacement therapy are presented. The paper presents the current hydration regimens and describes the principles of their modification depending on the clinical characteristics of patients, proposed by experts from the Scientific Society of Nephrology of Russia and the consensus of the American College of Radiology, the US National Kidney Foundation.