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
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Figure 1 CRS Type 1
Pathophysiological interactions between heart and kidney in type 1 cardiorenal syndrome (CRS) or "acute CRS" (abrupt worsening of cardiac function, e.g., acute cardiogenic shock or acute decompensation of chronic heart failure) leading to kidney injury. ACE = angiotensin-converting enzyme; ANP = atrial natriuretic peptide; BNP = B-type natriuretic peptide; CO = cardiac output; GFR = glomerular filtration rate; KIM = kidney injury molecule; N-GAL = neutrophil gelatinase-associated lipocalin; RAA = renin angiotensin aldosterone. Figure illustration by Rob Flewell.
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Figure 2 CRS Type 2
Pathophysiological interactions between heart and kidney in type 2 cardiorenal syndrome (CRS) or "chronic CRS" (chronic abnormalities in cardiac function, e.g., chronic heart failure) causing progressive chronic kidney disease (CKD). Figure illustration by Rob Flewell. LVH = left ventricular hypertrophy; RAA = renin angiotensin aldosterone.
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Figure 3 CRS Type 3
Pathophysiological interactions between heart and kidney in type 3 CRS or "acute renocardiac syndrome" (abrupt worsening of renal function, e.g., acute kidney failure or glomerulonephritis) causing acute cardiac disorder (e.g., heart failure, arrhythmia, pulmonary edema). MPO = myeloperoxidase; other abbreviations as in Figure 1. Figure illustration by Rob Flewell.
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Figure 4 CRS Type 4
Pathophysiological interactions between heart and kidney in type 4 cardiorenal syndrome (CRS) or "chronic renocardiac syndrome" (chronic kidney disease [CKD], e.g., chronic glomerular disease, contributing to decreased cardiac function, cardiac hypertrophy, or increased risk of adverse cardiovascular events). BMI = body mass index; EPO = erythropoietin; LDL = low-density lipoprotein. Figure illustration by Rob Flewell.
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Figure 5 CRS Type 5
Pathophysiological interactions between heart and kidney in type 5 cardiorenal syndrome (CRS) or "secondary CRS" (systemic condition, e.g., diabetes mellitus, sepsis, causing both cardiac and renal dysfunction). LPS = lipopolysaccharide (endotoxin); RVR = renal vascular resistance. Figure illustration by Rob Flewell.
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