Four patients are presented aged over 65 years in whom a state of
cardiogenic shock was present due to
myocardial infarction of the following localization: anterior in two and posterior in two. According to the parameters all patients satisfied the criteria of
cardiogenic shock. Of the four patients three died. In all patients parameters of renal lesion were analyzed after establishment of diureses:
sodium in urine,
creatinine quotient in urine and plasma, osmolality of urine, osmolality quotient of urine and plasma, the
renal failure index and the excretional fraction of filtered
sodium. The parameters quoted were analyzed the day after diuresis was established. All parameters, apart from
sodium in urine, indicated functional
oliguria. In corroboration of this were the values of
creatinine clearance which were determined the day after establishing diuresis, amounting in all patients to more than 20 ml/min./1.73 m2, i.e. ranging from 20.6 to 59.0 ml/min./1.73 m2. Of the cases which ended fatally all had
fibroses and myocardial
scars, apart from recent
infarction of the myocardium, generalized
atherosclerosis particularly of the coronary arteries, and in all patients
hypertrophy of the left ventricle and dilatation of the whole heart. In one patient anaemic
infarction of one kidney was found and in another acute tubular
necrosis (with the
renal failure index of 0.3 and the excretional fraction of filtered
sodium of 0.2), while in third patient no renal changes were found.