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STATE-OF-THE-ART PAPER

Cardiorenal Syndrome

Claudio Ronco, MD^_*,_*, Mikko Haapio, MD, Andrew A. House, MSc, MD, Nagesh Anavekar, MD and Rinaldo Bellomo, MD^¶

^_* Department of Nephrology, St. Bortolo Hospital, Vicenza, Italy
Division of Nephrology, Helsinki University Central Hospital, Helsinki, Finland
Division of Nephrology, London Health Sciences Centre, London, Ontario, Canada
Department of Cardiology, Northern Hospital, Melbourne, Australia
^¶ Department of Intensive Care, Austin Hospital, Melbourne, Australia

Manuscript received June 12, 2008; revised manuscript received July 14, 2008, accepted July 28, 2008.

^_* Reprint requests and correspondence: Dr. Claudio Ronco, Department of Nephrology, St. Bortolo Hospital, Viale Rodolfi 37, 36100 Vicenza, Italy (Email: cronco{at}goldnet.it).

The term cardiorenal syndrome (CRS) increasingly has been used without a consistent or well-accepted definition. To include the vast array of interrelated derangements, and to stress the bidirectional nature of heart-kidney interactions, we present a new classification of the CRS with 5 subtypes that reflect the pathophysiology, the time-frame, and the nature of concomitant cardiac and renal dysfunction. CRS can be generally defined as a pathophysiologic disorder of the heart and kidneys whereby acute or chronic dysfunction of 1 organ may induce acute or chronic dysfunction of the other. Type 1 CRS reflects an abrupt worsening of cardiac function (e.g., acute cardiogenic shock or decompensated congestive heart failure) leading to acute kidney injury. Type 2 CRS comprises chronic abnormalities in cardiac function (e.g., chronic congestive heart failure) causing progressive chronic kidney disease. Type 3 CRS consists of an abrupt worsening of renal function (e.g., acute kidney ischemia or glomerulonephritis) causing acute cardiac dysfunction (e.g., heart failure, arrhythmia, ischemia). Type 4 CRS describes a state of chronic kidney disease (e.g., chronic glomerular disease) contributing to decreased cardiac function, cardiac hypertrophy, and/or increased risk of adverse cardiovascular events. Type 5 CRS reflects a systemic condition (e.g., sepsis) causing both cardiac and renal dysfunction. Biomarkers can contribute to an early diagnosis of CRS and to a timely therapeutic intervention. The use of this classification can help physicians characterize groups of patients, provides the rationale for specific management strategies, and allows the design of future clinical trials with more accurate selection and stratification of the population under investigation.

Key Words: chronic kidney disease • heart failure • cardiorenal syndrome • renocardiac syndrome • heart-kidney interaction • biomarkers • cardiovascular risk

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   AKI = acute kidney injury   ARB = angiotensin receptor blocker   BNP = B-type natriuretic peptide   CKD = chronic kidney disease   CRS = cardiorenal syndrome   GFR = glomerular filtration rate   HF = heart failure   ICU = intensive care unit   IL = interleukin   LV = left ventricular   NGAL = neutrophil gelatinase-associated lipocalin   TNF = tumor necrosis factor

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J. Am. Coll. Cardiol. 2008 52: A40. [Full Text] [PDF]