Cardiorenal Syndrome Type 1

Cardiorenal syndrome (CRS) type 1 is characterized as the development of acute kidney injury (AKI) and dysfunction in the patient with acute cardiac illness, most commonly acute decompensated heart failure (ADHF). There is evidence in the literature supporting multiple pathophysiological mechanisms...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2012-09, Vol.60 (12), p.1031-1042
Main Authors: Ronco, Claudio, MD, Cicoira, Mariantonietta, MD, McCullough, Peter A., MD, MPH
Format: Article
Language:English
Subjects:
acute kidney injury
Adipocytes
Cardiology
cardiorenal syndrome
Cardiovascular
Chronic illnesses
Drug resistance
fluid overload
Heart attacks
Heart failure
hemodialysis
hemofiltration
Internal Medicine
Kidney diseases
Mortality
oliguria
Oxidative stress
Peptides
Proteins
refractory edema
Rodents
ultrafiltration
Weight control
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Summary:Cardiorenal syndrome (CRS) type 1 is characterized as the development of acute kidney injury (AKI) and dysfunction in the patient with acute cardiac illness, most commonly acute decompensated heart failure (ADHF). There is evidence in the literature supporting multiple pathophysiological mechanisms operating simultaneously and sequentially to result in the clinical syndrome characterized by a rise in serum creatinine, oliguria, diuretic resistance, and in many cases, worsening of ADHF symptoms. The milieu of chronic kidney disease has associated factors including obesity, cachexia, hypertension, diabetes, proteinuria, uremic solute retention, anemia, and repeated subclinical AKI events all work to escalate individual risk of CRS in the setting of ADHF. All of these conditions have been linked to cardiac and renal fibrosis. In the hospitalized patient, hemodynamic changes leading to venous renal congestion, neurohormonal activation, hypothalamic-pituitary stress reaction, inflammation and immune cell signaling, systemic endotoxemic exposure from the gut, superimposed infection, and iatrogenesis all contribute to CRS type 1. The final common pathway of bidirectional organ injury appears to be cellular, tissue, and systemic oxidative stress that exacerbate organ function. This review explores in detail the pathophysiological pathways that put a patient at risk and then effectuate the vicious cycle now recognized as CRS type 1.
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2012.01.077