Skip to main content
SpringerLink
Log in

Cardiorenal syndrome: refining the definition of a complex symbiosis gone wrong

  • Physiological and Technical Notes
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Background

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.

Discussion

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.

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  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 47:76–84

    Article  PubMed  Google Scholar 

  2. Stevenson LW, Nohria A, Mielniczuk L (2005) Torrent or torment from the tubules? Challenge of the cardiorenal connections. J Am Coll Cardiol 45:2004–2007

    Article  PubMed  Google Scholar 

  3. Kimmenade RR van, Januzzi JL Jr, Baggish AL, Lainchbury JG, Bayes-Genis A, Richards AM, Pinto YM (2006) Amino-terminal pro-brain natriuretic peptide, renal function, and outcomes in acute heart failure: redefining the cardiorenal interaction? J Am Coll Cardiol 48:1621–1627

    Article  CAS  Google Scholar 

  4. Bongartz LG, Cramer MJ, Doevendans PA, Joles JA, Braam B (2005) The severe cardiorenal syndrome: ‘Guyton revisited’. Eur Heart J 26:11–17

    Article  PubMed  Google Scholar 

  5. Tsagalis G, Zerefos S, Zerefos N (2007) Cardiorenal syndrome at different stages of chronic kidney disease. Int J Artif Organs 30:564–576

    PubMed  CAS  Google 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 17:1444–1452

    Article  PubMed  CAS  Google Scholar 

  7. Silverberg DS, Wexler D, Iaina A, Steinbruch S, Wollman Y, Schwartz D (2006) Anemia, chronic renal disease and congestive heart failure-the cardio renal anemia syndrome: the need for cooperation between cardiologists and nephrologists. Int Urol Nephrol 38:295–310

    Article  PubMed  Google Scholar 

  8. Domanovits H, Schillinger M, Mullner M, Thoennissen J, Sterz F, Zeiner A, Druml W (2001) Acute renal failure after successful cardiopulmonary resuscitation. Intensive Care Med 27:1194–1199

    Article  PubMed  CAS  Google Scholar 

  9. Neuhofer W, Pittrow D (2006) Role of endothelin and endothelin receptor antagonists in renal disease. Eur J Clin Invest 36 Suppl 3:78–88

    Article  PubMed  CAS  Google Scholar 

  10. Kuitunen A, Vento A, Suojaranta-Ylinen R, Pettila V (2006) Acute renal failure after cardiac surgery: evaluation of the RIFLE classification. Ann Thorac Surg 81:542–546

    Article  PubMed  Google Scholar 

  11. Bellomo R, Kellum JA, Ronco C (2007) Defining and classifying acute renal failure: from advocacy to consensus and validation of the RIFLE criteria. Intensive Care Med 33:409–413

    Article  PubMed  Google 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 105:1348–1353

    Article  PubMed  CAS  Google Scholar 

  13. Komajda M, Anker SD, Charlesworth A, Okonko D, Metra M, Di Lenarda A, Remme W, Moullet C, Swedberg K, Cleland JG, Poole-Wilson PA (2006) The impact of new onset anaemia on morbidity and mortality in chronic heart failure: results from COMET. Eur Heart J 27:1440–1446

    Article  PubMed  Google Scholar 

  14. Struthers AD, MacDonald TM (2004) Review of aldosterone- and angiotensin II-induced target organ damage and prevention. Cardiovasc Res 61:663–670

    Article  PubMed  CAS  Google Scholar 

  15. Onozato ML, Tojo A, Kobayashi N, Goto A, Matsuoka H, Fujita T (2007) Dual blockade of aldosterone and angiotensin II additively suppresses TGF-beta and NADPH oxidase in the hypertensive kidney. Nephrol Dial Transplant 22:1314–1322

    Article  PubMed  CAS  Google 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 53:1264–1272

    Article  PubMed  CAS  Google Scholar 

  17. Kelly KJ (2006) Acute renal failure: much more than a kidney disease. Semin Nephrol 26:105–113

    Article  PubMed  CAS  Google Scholar 

  18. Deswal A, Petersen NJ, Feldman AM, Young JB, White BG, Mann DL (2001) Cytokines and cytokine receptors in advanced heart failure: an analysis of the cytokine database from the Vesnarinone trial (VEST). Circulation 103:2055–2059

    PubMed  CAS  Google Scholar 

  19. Berl T, Henrich W (2006) Kidney-heart interactions: epidemiology, pathogenesis, and treatment. Clin J Am Soc Nephrol 1:8–18

    Article  PubMed  CAS  Google Scholar 

  20. Tonelli M, Wiebe N, Culleton B, House A, Rabbat C, Fok M, McAlister F, Garg AX (2006) Chronic kidney disease and mortality risk: a systematic review. J Am Soc Nephrol 17:2034–2047

    Article  PubMed  Google Scholar 

  21. Fort J (2005) Chronic renal failure: a cardiovascular risk factor. Kidney Int Suppl 99:S25–S29

    Google Scholar 

  22. Schiffrin EL, Lipman ML, Mann JF (2007) Chronic kidney disease: effects on the cardiovascular system. Circulation 116:85–97

    Article  PubMed  Google Scholar 

  23. Meyer TW, Hostetter TH (2007) Uremia. N Engl J Med 357:1316–1325

    Article  PubMed  CAS  Google Scholar 

  24. Movilli E, Feliciani A, Camerini C, Brunori G, Zubani R, Scolari F, Parrinello G, Cancarini GC (2005) A high calcium-phosphate product is associated with high C-reactive protein concentrations in hemodialysis patients. Nephron Clin Pract 101:c161–c167

    Article  PubMed  CAS  Google Scholar 

  25. Periyasamy SM, Chen J, Cooney D, Carter P, Omran E, Tian J, Priyadarshi S, Bagrov A, Fedorova O, Malhotra D, Xie Z, Shapiro JI (2001) Effects of uremic serum on isolated cardiac myocyte calcium cycling and contractile function. Kidney Int 60:2367–2376

    Article  PubMed  CAS  Google 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 90:297–303

    Article  PubMed  CAS  Google Scholar 

  27. Carr SJ, Bavanandan S, Fentum B, Ng L (2005) Prognostic potential of brain natriuretic peptide (BNP) in predialysis chronic kidney disease patients. Clin Sci (Lond) 109:75–82

    Article  CAS  Google Scholar 

  28. Apple FS, Murakami MM, Pearce LA, Herzog CA (2004) Multi-biomarker risk stratification of N-terminal pro-B-type natriuretic peptide, high-sensitivity C-reactive protein, and cardiac troponin T and I in end-stage renal disease for all-cause death. Clin Chem 50:2279–2285

    Article  PubMed  CAS  Google 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 18:321–330

    Article  PubMed  CAS  Google 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 18:904–912

    Article  PubMed  CAS  Google Scholar 

  31. Honore PM, Joannes-Boyau O, Boer W (2007) The early biomarker of acute kidney injury: in search of the Holy Grail. Intensive Care Med 33:1866–1868

    Article  PubMed  CAS  Google Scholar 

  32. Mishra J, Ma Q, Prada A, Mitsnefes M, Zahedi K, Yang J, Barasch J, Devarajan P (2003) Identification of neutrophil gelatinase-associated lipocalin as a novel early urinary biomarker for ischemic renal injury. J Am Soc Nephrol 14:2534–2543

    Article  PubMed  CAS  Google Scholar 

  33. Mishra J, Dent C, Tarabishi R, Mitsnefes MM, Ma Q, Kelly C, Ruff SM, Zahedi K, Shao M, Bean J, Mori K, Barasch J, Devarajan P (2005) Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet 365:1231–1238

    Article  PubMed  CAS  Google Scholar 

  34. Herget-Rosenthal S, Marggraf G, Husing J, Goring F, Pietruck F, Janssen O, Philipp T, Kribben A (2004) Early detection of acute renal failure by serum cystatin C. Kidney Int 66:1115–1122

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nephrology, St. Bortolo Hospital, Vicenza, Italy

    Claudio Ronco

  2. Division of Nephrology, London Health Sciences Centre, London, Canada

    Andrew A. House

  3. Division of Nephrology, HUCH Meilahti Hospital, Haartmaninkatu 4, Helsinki, Finland

    Mikko Haapio

Authors
  1. Claudio Ronco
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew A. House
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mikko Haapio
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mikko Haapio.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ronco, C., House, A.A. & Haapio, M. Cardiorenal syndrome: refining the definition of a complex symbiosis gone wrong. Intensive Care Med 34, 957–962 (2008). https://doi.org/10.1007/s00134-008-1017-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-008-1017-8

Keywords

Search

Navigation