title: Cardio-renal syndrome: an entity cardiologists and nephrologists should be dealing with collegially.
abstract: Heart failure may lead to acute kidney injury and vice versa. Chronic kidney disease may affect the clinical outcome in terms of cardiovascular morbidity and mortality while chronic heart failure may cause CKD. All these disorders contribute to the composite definition of cardio-renal syndromes. Renal impairment in HF patients has been increasingly recognized as an independent risk factor for morbidity and mortality; however, the most important clinical trials in HF tend to exclude patients with significant renal dysfunction. The mechanisms whereby renal insufficiency worsens the outcome in HF are not known, and several pathways could contribute to the "vicious heart/kidney circle." Traditionally, renal impairment has been attributed to the renal hypoperfusion due to reduced cardiac output and decreased systemic pressure. The hypovolemia leads to sympathetic activity, increased renin-angiotensin-aldosterone pathways and arginine-vasopressin release. All these mechanisms cause fluid and sodium retention, peripheral vasoconstriction and an increased congestion as well as cardiac workload. Therapy addressed to improve renal dysfunction, reduce neurohormonal activation and ameliorate renal blood flow could lead to a reduction in mortality and hospitalization in patients with cardio-renal syndrome.
authors.affiliation: Department of Internal Medicine and Metabolic Diseases, Cardiology Section, University of Siena, Siena, Italy. palazzuoli2@unisi.it
authors.forename: Alberto
authors.initials: A
authors.lastname: Palazzuoli
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
mesh_terms: D015415:Biomarkers; D002302:Cardiac Output / Q000187:drug effects; D059347:Cardio-Renal Syndrome / Q000188:drug therapy / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology; D002317:Cardiovascular Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D018450:Disease Progression; D004232:Diuretics / Q000009:adverse effects*; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D033183:Interdisciplinary Communication; D007668:Kidney / Q000098:blood supply / Q000503:physiopathology; D007677:Kidney Function Tests; D054539:Medication Therapy Management / Q000458:organization & administration; D018579:Patient Selection; D017597:Renal Blood Flow, Effective / Q000187:drug effects; D012084:Renin-Angiotensin System / Q000187:drug effects; D012307:Risk Factors; D012769:Shock / Q000188:drug therapy / Q000378:metabolism / Q000503:physiopathology; D014883:Water-Electrolyte Imbalance / Q000188:drug therapy / Q000503:physiopathology*
chemical_list: D015415:Biomarkers; D002317:Cardiovascular Agents; D004232:Diuretics