Cardiorenal syndrome: refining the definition of a complex symbiosis gone wrong
- 1.2k Downloads
The term “cardiorenal syndrome” has generally been reserved for declining renal function in the setting of advanced congestive heart failure. Considering the complex and bi-directional relationship between the heart and the kidneys, we postulate refining the definition to recognize the symbiotic nature of these organs.
We divide the cardiorenal syndrome into five subtypes: type I, acute cardiorenal syndrome; type II, chronic cardiorenal syndrome; type III, acute renocardiac syndrome; type IV, chronic renocardiac syndrome; and type V, secondary cardiorenal syndrome.
As early recognition of dysfunction in one organ may prove important in mitigating the spiral of co-dysfunction in both, the need for early and treatment-guiding biomarkers, along with their characteristics, are also discussed.
KeywordsCardiorenal syndrome Renocardiac syndrome Heart failure Congestive Kidney failure Biological markers
- 1.Yancy CW, Lopatin M, Stevenson LW, De Marco T, Fonarow GC, ADHERE Scientific Advisory Committee and Investigators (2006) Clinical presentation, management, and in-hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function: a report from the Acute Decompensated Heart Failure National Registry (ADHERE) Database. J Am Coll Cardiol 47:76–84PubMedCrossRefGoogle Scholar
- 6.Ishani A, Grandits GA, Grimm RH, Svendsen KH, Collins AJ, Prineas RJ, Neaton JD (2006) Association of single measurements of dipstick proteinuria, estimated glomerular filtration rate, and hematocrit with 25-year incidence of end-stage renal disease in the multiple risk factor intervention trial. J Am Soc Nephrol 17:1444–1452PubMedCrossRefGoogle Scholar
- 12.Gottlieb SS, Brater DC, Thomas I, Havranek E, Bourge R, Goldman S, Dyer F, Gomez M, Bennett D, Ticho B, Beckman E, Abraham WT (2002) BG9719 (CVT-124), an A1 adenosine receptor antagonist, protects against the decline in renal function observed with diuretic therapy. Circulation 105:1348–1353PubMedCrossRefGoogle Scholar
- 16.Spanaus KS, Kronenberg F, Ritz E, Schlapbach R, Fliser D, Hersberger M, Kollerits B, Konig P, von Eckardstein A, Mild-to-Moderate Kidney Disease Study Group (2007) B-type natriuretic peptide concentrations predict the progression of nondiabetic chronic kidney disease: the Mild-to-Moderate Kidney Disease Study. Clin Chem 53:1264–1272PubMedCrossRefGoogle Scholar
- 21.Fort J (2005) Chronic renal failure: a cardiovascular risk factor. Kidney Int Suppl 99:S25–S29Google Scholar
- 26.Groenning BA, Raymond I, Hildebrandt PR, Nilsson JC, Baumann M, Pedersen F (2004) Diagnostic and prognostic evaluation of left ventricular systolic heart failure by plasma N-terminal pro-brain natriuretic peptide concentrations in a large sample of the general population. Heart 90:297–303PubMedCrossRefGoogle Scholar
- 29.Wang AY, Lam CW, Yu CM, Wang M, Chan IH, Zhang Y, Lui SF, Sanderson JE (2007) N-terminal pro-brain natriuretic peptide: an independent risk predictor of cardiovascular congestion, mortality, and adverse cardiovascular outcomes in chronic peritoneal dialysis patients. J Am Soc Nephrol 18:321–330PubMedCrossRefGoogle Scholar
- 30.Liangos O, Perianayagam MC, Vaidya VS, Han WK, Wald R, Tighiouart H, MacKinnon RW, Li L, Balakrishnan VS, Pereira BJ, Bonventre JV, Jaber BL (2007) Urinary N-acetyl-beta-(D)-glucosaminidase activity and kidney injury molecule-1 level are associated with adverse outcomes in acute renal failure. J Am Soc Nephrol 18:904–912PubMedCrossRefGoogle Scholar