08/05/2026
Interesante
Following pacemaker implantation, rapid clinical improvement was observed.
A 14-year-old Miniature Pinscher was presented with azotemia, severe hyperkalemia, and oliguria, attributed to decompensation of chronic kidney disease, along with marked bradycardia secondary to third-degree atrioventricular (AV) block.
Supportive medical therapy was initiated to address the renal dysfunction and electrolyte abnormalities. However, within 12 hours of hospitalization, the patient developed acute multifocal neurologic signs, including nystagmus, quadriparesis, decreased mentation, and ventral neck flexion
These findings supported a diagnosis of cardio–renal–cerebral syndrome, reflecting the interplay between cardiac, renal, and neurologic dysfunction.
In this case, the third-degree AV block resulted in severe bradycardia, leading to a marked reduction in cardiac output. This decrease in forward flow likely caused systemic hypoperfusion, affecting both the kidneys and the brain.
Reduced renal perfusion contributed to:
• Worsening azotemia and oliguria
• Impaired potassium excretion, exacerbating hyperkalemia
At the same time, decreased cerebral perfusion led to the observed acute neurologic deficits.
Although hyperkalemia can induce conduction abnormalities, the persistence of complete AV block despite partial correction of potassium levels suggests that the cardiac dysfunction was primary, rather than secondary to electrolyte imbalance
This sequence supports a model in which cardiac dysfunction initiated a cascade of renal and neurologic injury, consistent with cardiorenal cerebral syndrome.
To address the underlying hemodynamic compromise, a transvenous permanent pacemaker was implanted to restore adequate heart rate and cardiac output.
Following pacemaker placement:
• Neurologic signs rapidly resolved
• Urine production improved
• Renal parameters began to stabilize
Clinical improvement was observed within 24 hours, and the patient was discharged by day 3 with continued recovery
G. Candelario, G. Kramer, B. Williams, S. Siess, N. Gaudette, and L. Patterson Rosa, “ Reversible Cardio-Renal-Cerebral Syndrome in a Dog: A Case Report,” Journal of Veterinary Internal Medicine 39, no. 6 (2025): e70249,
