Acute cardio-renal syndrome: progression from congestive heart failure to congestive kidney failure.
Over the past few years, acute worsening of renal function has emerged as a powerful and independent predictor of adverse cardiac outcomes among patients hospitalized with acute heart failure exacerbation. This phenomenon has been recently termed acute cardio-renal syndrome. Acute cardio-renal syndrome is not uncommon, affecting roughly one third of acute decompensated heart failure patients. The mechanism of acute cardio-renal syndrome is poorly understood and difficult to elucidate in light of the complex and multifactorial comorbidities associated with acute heart failure syndrome. Acute cardio-renal syndrome is commonly explained by hypoperfusion of the kidney with intravascular volume depletion, hypotension and low flow state ("pre-renal syndrome"). This perception, however, is challenged by the actual hemodynamics present during acute cardio-renal syndrome characterized by hypervolemia, normal cardiac output, and elevated filling pressures of the systemic and venous circulation. This review discusses the long-standing and unnoticed evidence in support of the notion that right-sided failure with raised filling pressure of the renal vein by itself can indeed lead to acute worsening renal function with oliguria, azotemia, and reduced glomerular filtration rate.
Wencker
Detlef
D
Department of Medicine, Section of Cardiovascular Disease, Yale University School of Medicine, 135 College Street, Suite 301, New Haven, CT 06510, USA. Detlef.wencker@yale.edu
D000208:Acute Disease; D018450:Disease Progression; D005919:Glomerular Filtration Rate / Q000502:physiology; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D051437:Renal Insufficiency / Q000209:etiology* / Q000503:physiopathology; D013577:Syndrome