Heart Failure Reviews

, Volume 23, Issue 2, pp 291–302 | Cite as

The dark side of the kidney in cardio-renal syndrome: renal venous hypertension and congestive kidney failure

  • Pierpaolo Di Nicolò


Renal involvement in some forms of acute or chronic diseases, such as heart failure or sepsis, presents with a complex pathophysiological basis that is not always clearly distinguishable. In these clinical settings, kidney failure is traditionally and almost exclusively attributed to renal hypoperfusion and it is commonly accepted that causal elements are pre-renal, such as a reduction in the ejection fraction or absolute or relative hypovolemia acting directly on oxygen transport mechanisms and renal autoregulation systems, causing a reduction of glomerular filtration rate. Nevertheless, the concept emerging from accumulating clinical and experimental evidence is that in complex clinical pictures, kidney failure is strongly linked to the hemodynamic alterations occurring in the renal venous micro and macrocirculation. Accordingly, the transmission of the increased venous pressure to the renal venous compartment and the consequent increasing renal afterload has a pivotal role in determining and sustaining the kidney damage. The aim of this review was to clarify the physiopathological aspects of the link between worsening renal function and renal venous hypertension, analyzing the prognostic and therapeutic implications of the so-called congestive kidney failure in cardio-renal syndrome and in other clinical contexts of its possible onset.


Cardio-renal syndrome Renal venous hypertension Congestive kidney Heart failure Acute kidney injury 



The author wishes to thank Mrs. Manfredonia Monica for his valuable and competent contribution in projecting and producing the figures in the text.


The author declares that he has received no financial contributions or economic sponsorship for writing this article.

Compliance with ethical standards

Conflict of interest

The author declares that no conflict of interest exists.

The author declares that the manuscript does not contain images and/or tables subject to authorization.

The author declares that the manuscript has not been published before and that it is not under consideration for publication anywhere else.


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Nephrology and Dialysis Unit“S. Maria della Scaletta” HospitalImolaItaly

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