Improving Prognosis of Heart Failure Patients & the CardioRenal syndrome

This study published in Circulation describes how sympathetic denervation of the kidneys eliminated albuminuria in a rat model of heart failure. I think this study has great significance. The combination of heart and kidney dysfunction is known as the cardiorenal syndrome and carries a terrible prognosis. Renal denervation therefore has the potential to improve the prognosis of patients with heart failure. Renal sympathectomy can now be performed relatively non-invasively through a catheter. It has been shown to be effective in treating very resistant hypertension. So watch this space!

p.s. Just read that Dick Cheney has just had a heart transplant.  I know that he has had heart failure for years - he must have had good renal function to have lasted this long. 

Does Atrial Fibrillation cause renal failure?

This article, published very recently in Circulation excites me! It describes a retrospective study from Japan of patients with atrial fibrillation who also happen to have  diminished renal function. This renal impairment improves after successful ablation.
Either something important and new is being described (which is exciting) or confounding factors (such as change of drug regimen) have been missed. The sceptic in me would go for the latter whereas the optimist would go for the former. The hypothesis could be confirmed or dismissed by a properly conducted trial.
If AF is proven to make renal function worse AND ablation reverses this decline, then the case for ablation is strengthened - which is also good, as ablation for AF (concomitant with other cardiac surgery) is one of my interest - hence the nerdish excitement! 

POOR RENAL FUNCTION AND MYOCARDIAL NECROSIS

NDT
This is a very interesting study. One wonders whether if this increased level of myocardial necrosis associated with diminished renal function applies to global cardiac ischaemia that occurs in cardiac surgery. It is well known that any degree of renal dysfunction is associated with poorer outcomes after cardiac surgery. This phenomenon may explain why.
What is not known and what surely must be a good avenue for study is why does impaired renal function lead to increased myocardial necrosis?