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Cardiorenal Syndrome 1: What’s in a Name?

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Annual Update in Intensive Care and Emergency Medicine 2023

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM))

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Abstract

An acute cardiac event leading to acute kidney injury (AKI) is called cardiorenal syndrome type 1 (CRS-1). Depending on the underlying cardiac disorder, the pathophysiology and hence management of CRS-1 can be different. CRS-1 is frequent in patients with acute heart failure and in patients following cardiac surgery and has a negative impact on prognosis. Congestion and perfusion state is essential in the pathogenesis of CRS-1. Other contributing factors are activation of neurohormonal pathways and induction of inflammatory cascades.

Defining CRS-1 in this specific population is challenging due to several limitations. Differentiation between functional AKI, subclinical AKI, and true AKI, based on biomarker assessment, should be targeted in further research. Management of CRS-1 in acute heart failure and after cardiac surgery should primarily focus on hemodynamic optimization which should be tailored to the main mechanism of cardiac dysfunction. Effective and complete decongestion together with achieving normal perfusion will stabilize CRS-1 in most cases. Renal replacement therapy (RRT) is seldom needed and its initiation is based on classic indications of hyperkalemia, metabolic acidosis, and diuretic-resistant fluid overload. Interruptions in goal-directed medical heart failure treatment should be minimized. Other causes of AKI in this patient population should be excluded and treated.

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Authors and Affiliations

  1. Intensive Care Unit, Ghent University Hospital, Ghent University, Gent, Belgium

    H. A. I. Schaubroeck, W. Vandenberghe & E. A. J. Hoste

  2. Research Foundation-Flanders (FWO), Brussels, Belgium

    E. A. J. Hoste

Authors
  1. H. A. I. Schaubroeck
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  2. W. Vandenberghe
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  3. E. A. J. Hoste
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Correspondence to H. A. I. Schaubroeck .

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Editors and Affiliations

  1. Department of Intensive Care, Erasme University Hospital Université libre de Bruxelles, Brussels, Belgium

    Jean-Louis Vincent

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Schaubroeck, H.A.I., Vandenberghe, W., Hoste, E.A.J. (2023). Cardiorenal Syndrome 1: What’s in a Name?. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2023. Annual Update in Intensive Care and Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-031-23005-9_27

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  • DOI: https://doi.org/10.1007/978-3-031-23005-9_27

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