CARDIORENAL SYNDROME AS EXTRA-ARTICULAR MANIFESTATION OF RHEUMATOID ARTHRITIS

Abstract

The article provides a description of a complex clinical case of cardiorenal syndrome type II in a patient having rheumatoid arthritis and a high degree of activity. The aim of this work is to highlight the problem of multiple organ damage in severe autoimmune diseases, as well as to share the experience of diagnostic and therapeutic approaches in such situations. Under a long-term articular syndrome, the patient subacutely develops new threatening symptoms: signs of inflammatory cardiomyopathy, heart failure, nephropathy, acute renal failure. But thanks to intensive anti-inflammatory therapy, we managed to significantly mitigate the activity of myocarditis, restore myocardial, and as a result, renal function. The success of active anti-inflammatory treatment confirmed our diagnostic hypothesis of cardiorenal syndrome. Several clinical landmarks have become key points for us. First, we detected that myocarditis with myocardial dysfunction and nephropathy with renal failure occurred almost simultaneously. Since the patient was under observation for a long time, until recently, we knew for sure that there were no pathological changes in the function of the heart and kidneys. Then, we detected the subacute onset of cardiac and renal symptoms. Finally, NSAID-induced amyloidosis or nephropathy cannot clearly explain the active course of inflammatory cardiomyopathy. Therefore, based on the characteristics of this clinical situation, we made an assumption of cardiorenal syndrome, most likely type II. All subtypes have similar clinical signs, but their origin largely depends on the underlying disease, history, and features of specific kidney and myocardial damage. Kidney hypoperfusion in our case did not lead to severe irreversible changes in nephrons, which ensured the restoration of renal function. But a prolonged and deep episode of hypoperfusion may be partially or completely irreversible, due to ischemic necrosis of the epithelium of the nephron tubules. Thus, we have shown a complex clinical case of an extra-articular lesion in the form of a cardiorenal syndrome, as well as an algorithm of our actions regarding diagnosis and treatment. Relatively early diagnosis of cardiorenal syndrome obviously enables to achieve good treatment results in a relatively short period of time.