A 41-year-old obese male patient is diagnosed with congestive heart failure (CHF)

A 41-year-old obese male patient is diagnosed with congestive heart failure (CHF). He is told to begin a moderate exercise routine with a healthy diet and is prescribed several medications — including a diuretic.

A 41-year-old obese male patient is diagnosed with congestive heart failure CHF

Congestive Heart Failure

A 41-year-old obese male patient is diagnosed with congestive heart failure (CHF). He is told to begin a moderate exercise routine with a healthy diet and is prescribed several medications — including a diuretic.

1.            Based on your knowledge of the kidney and the disease of CHF, what factors would be important in selecting a specific diuretic? How would you explain to this patient how it works?

2.            If this patient developed a disease that caused the renal blood flow to be diminished, how might this impact the medication he is taking for his congestive heart failure? As his health care provider, how would you change his treatment in this situation?

More details;

The following are key points to remember from this state-of-the-art review on diuretic therapy for patients with heart failure (HF):

Chronic kidney disease (CKD) is a strong predictor of adverse outcome in HF, and also CKD impairs the “reserve” available for the kidneys to respond to the insult posed by congestion.

In normal circumstances, renal blood flow (RBF) is around 20% of cardiac output. Mainly determined by differences in renal arterial and venous pressure. In HF, both natriuresis and maximal free water excretion are decreased.

RBF and glomerular filtration rate (GFR) are autoregulated by three major mechanisms:

Firstly, the myogenic response, the macula densa tubuloglomerular feedback,

Also, renin secretion.

All three of these processes serve to maintain the GFR constant, but at the expense of renin-angiotensin-aldosterone system activation.

HF is also characterized by a low distal tubular flow secondary to increased fractional reabsorption in the proximal parts of the tubules and often concomitantly decreased GFR.