Prevention of cardiorenal syndromes.
The cardiorenal syndromes (CRS) are composed of five recently defined syndromes which represent common clinical scenarios in which both the heart and the kidney are involved in a bidirectional injury process leading to dysfunction of both organs. Common to each subtype are multiple complex pathogenic factors, a precipitous decline in function and a progressive course. Most pathways that lead to CRS involve acute injury to organs which manifest evidence of chronic disease, suggesting reduced ability to sustain damage, maintain vital functions, and facilitate recovery. Prevention of CRS is an ideal clinical goal, because once initiated, CRS cannot be readily aborted, are not completely reversible, and are associated with serious consequences including hospitalization, complicated procedures, need for renal replacement therapy, and death. Principles of prevention include identification and amelioration of precipitating factors, optimal management of both chronic heart and kidney diseases, and future use of multimodality therapies for end-organ protection at the time of systemic injury. This paper will review the core concepts of prevention of CRS with practical applications to be considered in today's practice.
McCullough
Peter A
PA
Department of Medicine, Divisions of Cardiology, Nutrition and Preventive Medicine, William Beaumont Hospital, Royal Oak, Mich., USA.
D000740:Anemia / Q000517:prevention & control; D009320:Atrial Natriuretic Factor / Q000502:physiology; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004298:Dopamine / Q000097:blood; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D007262:Infusions, Intravenous; D007674:Kidney Diseases / Q000150:complications* / Q000503:physiopathology / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology / Q000517:prevention & control; D017202:Myocardial Ischemia / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D012079:Renal Circulation / Q000502:physiology; D020181:Sleep Apnea, Obstructive / Q000517:prevention & control; D012964:Sodium / Q000378:metabolism; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D013577:Syndrome
D002316:Cardiotonic Agents; D049994:Sodium Potassium Chloride Symporter Inhibitors; D009320:Atrial Natriuretic Factor; D012964:Sodium; D004298:Dopamine