Review article

Cardiorenal syndrome

Ivan Bubić ; Zavod za nefrologiju i dijalizu, Klinika za internu medicinu, Klinički bolnički centar Rijeka
Luka Zaputović ; Zavod za kardiovaskularne bolesti, Klinika za internu medicinu, Klinički bolnički centar Rijeka
Sanjin Rački ; Zavod za nefrologiju i dijalizu, Klinika za internu medicinu, Klinički bolnički centar Rijeka

Abstract

Renal dysfunction is often present in patients with heart failure, and vice versa,
patients with kidney disease have often concomitant heart dysfunction. This has led to the
concept of cardiorenal syndrome (CRS) as a pathophysiological disorder in which dysfunction
of one organ induces dysfunction in the other. It is subdivided into five subtypes depending
on the primacy of organ dysfunction and the time-frame of the syndrome. CRSs in
which heart and kidney are primary involved are named primary, and CRS in which systemic
conditions lead to simultaneous injury of heart and kidney are named secondary CRS. Involved
complex pathophysiological mechanisms are poorly understood. Renin-angiotensinaldosteron
system activation, endothelial dysfunction, sympathetic system activation and
inflammation are the fundamental principles in the development of this syndrome. In the
early diagnosis of renal dysfunction in CRS, new protein biomarkers are used, whose values
have increased already at a mild renal impairment, far before an increase of serum creatinine.
Since patients with CRS are often excluded from large clinical trials, we do not have
guidelines for the treatment of this syndrome. In every-day practice we usually employ empirical
treatment. Based on the concern of worsening kidney function, patients with CRS often
do not receive appropriate medication. Prevention of CRS is of enormous importance
because this syndrome is not completely reversible and are associated with higher hospitalization
rate, complicated procedures, need for renal replacement therapy, and death. Current
epidemiological and pathophysiological knowledge about CRS, as well as recommendations
for its treatment and prevention are reviewed.

Keywords

biomarkers; cardiovascular risk; chronic kidney disease; heart failure; management; prevention

Hrčak ID:

63062

URI

https://hrcak.srce.hr/63062

Publication date:

8.12.2010.

Article data in other languages: croatian

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