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Cardiorenal Syndrome and Heart Failure

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Congestive Heart Failure and Cardiac Transplantation

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Abstract

Renal dysfunction is a strong predictor of morbidity and mortality in heart failure patients. Similarly, heart failure is one of the most common complications of patients with renal dysfunction. This chapter summarizes the cardiorenal syndrome (CRS) caused by heart failure. Worsening renal failure is usually defined as an increase in serum creatinine (SCr) equal to or more than 0.3 mg/dl. Defining CRS has lacked clarity and consistency, changing from the progression of renal dysfunction secondary to heart failure to a broader description—as a pathophysiologic disorder of the heart and kidneys whereby acute or chronic dysfunction of one organ may induce acute or chronic dysfunction of the other. Its pathophysiology is not well understood. Five subtypes (types 1 through 5) categorize CRS based on its initial compromised organ and a patient’s symptoms and physical status. Diagnosis is challenging, especially in type 1 where increased serum creatinine sometimes reflects a preexisting injury and glomerular filtration rate (GFR) is not reliable in acute states given that formulas used to estimate GFR were validated in patients with stable renal function. Use of newly recognized biomarkers is at an experimental stage, so the gold standard for diagnosis remains clinical assessment. Patient management typically focuses on relieving congestion and improving hemodynamics to prevent worsening renal perfusion and failure and preventing activation of inflammatory responses that lead to glomerular and tubular damage. Brain natriuretic peptide is showing promise for both its natriuretic and vasodilatory properties. Research will improve our understanding of CRS’ underlying mechanisms and guide optimal treatment options for patients with heart failure.

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Authors and Affiliations

  1. Allegheny General Hospital McGinnis Cardiovascular Institute, 320 North East Avenue, 16th floor south tower, Pittsburgh, PA, 15212, USA

    Maria Patarroyo-Aponte MD

  2. Minneapolis Heart Institute at Abbott Northwestern Hospital, 920 E 28th Street, Suite 300, Minneapolis, MN, 55407, USA

    Peter M. Eckman MD

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  1. Maria Patarroyo-Aponte MD
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  2. Peter M. Eckman MD
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Correspondence to Peter M. Eckman MD .

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Editors and Affiliations

  1. Lillehei Heart Institute, Department of Medicine, University of Minnesota Medical Center, University of Minnesota, Minneapolis, Minnesota, USA

    Daniel J. Garry

  2. Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota, USA

    Robert F. Wilson

  3. Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota, USA

    Zeev Vlodaver

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Patarroyo-Aponte, M., Eckman, P.M. (2017). Cardiorenal Syndrome and Heart Failure. In: Garry, D., Wilson, R., Vlodaver, Z. (eds) Congestive Heart Failure and Cardiac Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-44577-9_15

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