Author + information
- Received January 9, 2012
- Accepted January 13, 2012
- Published online September 18, 2012.
- ↵⁎Reprint requests and correspondence:
Dr. Claudio Ronco, Department of Nephrology, Dialysis, and Transplantation, International Renal Research Institute, St. Bortolo Hospital, Viale Rodolfi 37, 36100 Vicenza, Italy
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.
- acute kidney injury
- cardiorenal syndrome
- fluid overload
- heart failure
- refractory edema
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 9, 2012.
- Accepted January 13, 2012.
- American College of Cardiology Foundation