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      Pathophysiology of the cardio-renal syndromes types 1–5: An uptodate

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          Abstract

          According to the recent definition proposed by the Consensus conference on Acute Dialysis Quality Initiative Group, the term cardio-renal syndrome (CRS) has been used to define different clinical conditions in which heart and kidney dysfunction overlap.

          Type 1 CRS (acute cardio- renal syndrome) is characterized by acute worsening of cardiac function leading to AKI (5, 6) in the setting of active cardiac disease such as ADHF, while type – 2 CRS occurs in a setting of chronic heart disease.

          Type 3 CRS is closely link to acute kidney injury (AKI), while type 4 represent cardiovascular involvement in chronic kidney disese (CKD) patients.

          Type 5 CRS represent cardiac and renal involvement in several diseases such as sepsis, hepato – renal syndrome and immune – mediated diseases.

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          Clinical epidemiology of cardiovascular disease in chronic renal disease.

          RN Foley, PS Parfrey, MJ Sarnak (1998)
          Article 0 comments Cited 643 times – based on 0 reviews     Review now
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            Importance of venous congestion for worsening of renal function in advanced decompensated heart failure.

            Wilfried Mullens, Zuheir Abrahams, Gary Francis … (2009)
            To determine whether venous congestion, rather than impairment of cardiac output, is primarily associated with the development of worsening renal function (WRF) in patients with advanced decompensated heart failure (ADHF). Reduced cardiac output is traditionally believed to be the main determinant of WRF in patients with ADHF. A total of 145 consecutive patients admitted with ADHF treated with intensive medical therapy guided by pulmonary artery catheter were studied. We defined WRF as an increase of serum creatinine >/=0.3 mg/dl during hospitalization. In the study cohort (age 57 +/- 14 years, cardiac index 1.9 +/- 0.6 l/min/m(2), left ventricular ejection fraction 20 +/- 8%, serum creatinine 1.7 +/- 0.9 mg/dl), 58 patients (40%) developed WRF. Patients who developed WRF had a greater central venous pressure (CVP) on admission (18 +/- 7 mm Hg vs. 12 +/- 6 mm Hg, p < 0.001) and after intensive medical therapy (11 +/- 8 mm Hg vs. 8 +/- 5 mm Hg, p = 0.04). The development of WRF occurred less frequently in patients who achieved a CVP <8 mm Hg (p = 0.01). Furthermore, the ability of CVP to stratify risk for development of WRF was apparent across the spectrum of systemic blood pressure, pulmonary capillary wedge pressure, cardiac index, and estimated glomerular filtration rates. Venous congestion is the most important hemodynamic factor driving WRF in decompensated patients with advanced heart failure.
            Article 0 comments Cited 393 times – based on 0 reviews     Review now
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              Chronic kidney disease: effects on the cardiovascular system.

              Ernesto Schiffrin, Mark L. Lipman, Johannes Mann (2007)
              Accelerated cardiovascular disease is a frequent complication of renal disease. Chronic kidney disease promotes hypertension and dyslipidemia, which in turn can contribute to the progression of renal failure. Furthermore, diabetic nephropathy is the leading cause of renal failure in developed countries. Together, hypertension, dyslipidemia, and diabetes are major risk factors for the development of endothelial dysfunction and progression of atherosclerosis. Inflammatory mediators are often elevated and the renin-angiotensin system is frequently activated in chronic kidney disease, which likely contributes through enhanced production of reactive oxygen species to the accelerated atherosclerosis observed in chronic kidney disease. Promoters of calcification are increased and inhibitors of calcification are reduced, which favors metastatic vascular calcification, an important participant in vascular injury associated with end-stage renal disease. Accelerated atherosclerosis will then lead to increased prevalence of coronary artery disease, heart failure, stroke, and peripheral arterial disease. Consequently, subjects with chronic renal failure are exposed to increased morbidity and mortality as a result of cardiovascular events. Prevention and treatment of cardiovascular disease are major considerations in the management of individuals with chronic kidney disease.
              Article 0 comments Cited 378 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                L. Di Lullo
                Journal
                Journal ID (nlm-ta): Indian Heart J
                Journal ID (iso-abbrev): Indian Heart J
                Title: Indian Heart Journal
                Publisher: Elsevier
                ISSN (Print): 0019-4832
                Publication date (Print): Mar-Apr 2017
                Publication date (Electronic): 22 January 2017
                Volume: 69
                Issue: 2
                Pages: 255-265
                Affiliations
                [a ]Department of Nephrology and Dialysis, L. Parodi – Delfino Hospital, Colleferro Rome, Italy
                [b ]Department of Nephrology and Dialysis, S. Anna Hospital, Como, Italy
                [c ]Division of Nephrology, University of Naples “Federico II”, Napoli, Italy
                [d ]Department of Nephrology and Dialysis, A. Landolfi Hospital, Solofra, Avellino, Italy
                [e ]Department of Health Sciences, Renal Division, San Paolo Hospital, University of Milan, Italy
                [f ]International Renal Research Institute, S. Bortolo Hospital, Vicenza, Italy
                Author notes
                [* ]Corresponding author. dilulloluca69@ 123456gmail.com
                Article
                Publisher ID: S0019-4832(16)30407-2
                DOI: 10.1016/j.ihj.2017.01.005
                PMC ID: 5415026
                PubMed ID: 28460776
                SO-VID: bcd298c0-e6ba-47d0-8857-11873da1e688
                Copyright © © 2017 Cardiological Society of India. Published by Elsevier B.V.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 26 August 2016
                Date accepted : 10 January 2017
                Categories
                Subject: Review

                Keywords: cardiorenal syndrome,heart failure,acute kidney injury,chronic kidney disease,sepsis
                Data availability:
                Keywords: cardiorenal syndrome, heart failure, acute kidney injury, chronic kidney disease, sepsis

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