Is using a CBC to look for normocytic and normochromic anemia, cystatin C to look for kidney specific protein and using pre and post renal creatinine values able to detect kidney failure in a patient? Is there any other way of detecting renal failure on a heart failure patient?
Heart failure is a pre-renal cause of acute kidney injury, and if the insult is prolonged enough, it can lead to Ischaemic tubular necrosis as well as chronic kidney disease. Acute kidney injury can be diagnosed by observing increase in serum creatinine by 0.3mg/dl (26.5micomol/l) within 48hours or an increase in serum creatinine to equal to/greater than 1.5 times baseline value which is known or presumed to have occurred within the prior 7days, or urine output that is less than 0.5ml/kg/hour for 6hours. There are urinary biomarkers for early detection of acute kidney injury from any cause (including heart failure); Kidney injury molecule -1, neutrophil gelatinase-associated lipocalin, sodium/hydrogen exchanger isoform 3, cytokines (IL-6, IL-8, IL-18), cysteine-rich protein 61, actin, alpha-glutathione-S-transferase, cystatin C (Curr Opin Crit Care 2004;10:476 - 482). If kidney damage from heart failure persists for up to or more than 3 months which can be evident either by persistent decline in GFR and or markers of kidney damage in the blood or urine, imaging abnormalities of the kidney, a diagnosis of chronic kidney disease (chronic renal failure) can be made.
Renal failure due to heart heart failure can arise acutely or chronicly. It is defined as cardiorenal syndrome Typ 1 (acute) or 2 (chronic). Depending on such time course different diagnostic tools are appropriate. In longer time courses serum crea, urea and GFR may detect CKD. In shorter period, in particular on the ICU, "faster" methods to detect renal detoriation are needed. Very helpful is hourly urine production (a criterion of acute kidney failure). OR serum markers like KIM-1, NGAL and orthers.