From the Guidelines
Yes, nephrotic syndrome can lead to heart failure due to the significant fluid overload and increased workload on the heart. Nephrotic syndrome causes significant protein loss in urine, resulting in low albumin levels in the blood (hypoalbuminemia) [ 1 ]. This triggers fluid retention throughout the body, including edema in the legs and abdomen. The fluid overload increases the workload on the heart as it must pump more volume. Additionally, nephrotic syndrome is associated with hyperlipidemia (high cholesterol and triglycerides) and hypercoagulability (increased blood clotting), which can accelerate atherosclerosis and increase the risk of coronary artery disease. The condition also causes sodium retention, further contributing to fluid overload and hypertension.
According to the European Guidelines on cardiovascular disease prevention in clinical practice [ 1 ], renal impairment is associated with the development of cardiovascular disease (CVD) and death. The increased risk is already present by the time microalbuminuria develops, and it progressively increases as renal function deteriorates. The development of renal impairment is associated with risk factors including age, hypertension, dyslipidaemia, and the metabolic syndrome, which are also CVD risk factors.
The European Society of Cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure [ 1 ] also highlight the importance of renal function in heart failure patients, stating that renal dysfunction is common in heart failure and is strongly linked to increased morbidity and mortality. Therefore, managing nephrotic syndrome and monitoring cardiac function is crucial to prevent the development of heart failure. Management typically involves treating the underlying cause of nephrotic syndrome, using diuretics like furosemide to reduce fluid overload, ACE inhibitors or ARBs to control blood pressure and reduce proteinuria, and statins to manage hyperlipidemia.
Key considerations in the management of nephrotic syndrome to prevent heart failure include:
- Regular monitoring of cardiac function
- Controlling blood pressure and reducing proteinuria with ACE inhibitors or ARBs
- Managing hyperlipidemia with statins
- Reducing fluid overload with diuretics like furosemide
- Treating the underlying cause of nephrotic syndrome [ 1 ].
From the Research
Nephrotic Syndrome and Heart Failure
- Nephrotic syndrome can lead to several complications, including progressive kidney dysfunction, which may increase the risk of heart failure 2.
- The hyperlipidemia associated with nephrotic syndrome can also increase the risk of atherosclerotic heart disease 3.
- A study found that virtually all patients with nephrotic syndrome had at least one risk factor for cardiovascular disease, and over two thirds had two risk factors 3.
- Another study presented a case of congestive cardiac failure and nephrotic range proteinuria in a patient with persistent fluid overload secondary to amyloid light-chain (AL) amyloidosis, highlighting the connection between nephrotic syndrome and heart failure 4.
Pathophysiological Mechanisms
- Proteinuria in nephrotic syndrome can lead to the formation of cellular or fibrous crescents, resulting in rapidly progressive glomerulonephritis or focal glomerulosclerosis 2.
- Hypoalbuminemia associated with nephrotic syndrome can increase the risk of mortality and kidney dysfunction 2.
- Dyslipidemia can increase the risk of atherosclerotic complications, cause podocyte dysfunction, and contribute to vascular thrombosis 2.
Clinical Use of Diuretics
- Diuretics play a significant role in the treatment of fluid overload in conditions such as cardiac failure, cirrhosis, and nephrotic syndrome 5.
- A systemic approach for management is recommended, starting from thiazides and proceeding to loop diuretics 5.
- The use of diuretics in patients with heart failure and nephrotic syndrome requires careful consideration of the potential risks and benefits, including the risk of acute renal failure 6.