Congestion and Compression in Cardiorenal Failure

Heart failure is a syndrome characterised by a disturbed fluid regulation. Due to numerous hormonal changes, the kidneys retain more salt. With this salt comes water, which accumulates in the tissues of the body. The retained fluid is the main cause of complaints in patients with heart failure. Part 1 of this thesis focuses on understanding the disordered fluid balance, with the aim of better treating it in the future. The various chapters examine, among other things, what different proteins in the blood and urine can tell us about the fluid balance and what happens to the fluid balance if we treat patients with diuretics other than those standardly used. In part 2 we discuss external pressures on the kidney. These pressures can be caused by an excess of fluid in the kidneys, high abdominal pressure or an excess of fat around the kidney. The first chapter of part 2 focuses on classifying and understanding the different types of pressure. In the second chapter we measured the amount of fat around the kidney in patients with heart failure and a preserved ejection fraction, and found that these patients had more fat than comparable people without heart failure. In addition, the amount of fat was related to renal dysfunction and higher pressure in the pulmonary arteries, a characteristic feature of heart failure.