title: Clinical impact of renal dysfunction in heart failure.
abstract: Renal impairment in heart failure (HF) patients has been increasingly recognized as an         independent risk factor for morbidity and mortality. In the most recent European and         American guidelines for HF management, renal dysfunction was considered an index of         poor prognosis independent of the presence of other traditionally investigated risk factors.         Different mechanisms appear to be implicated in worsening renal function in patients         with acute decompensated HF (ADHF) in contrast to chronic HF. In patients with acute         ADHF, renal impairment has been attributed to renal hypoperfusion due to reduced         cardiac output and decreased systemic blood pressure. In these patients, neurohormonal         activation of the renin-angiotensin and sympathetic nervous systems plays a key role. In         chronic and clinically stable HF, other mechanisms, including microvascular damage,         oxidative stress, inflammation, and fibrosis, lead to a reduced number of functioning         nephrons. Differentiating transient functional changes in renal filtration and acute renal         tubular injury with loss of functioning nephrons is a critical step in understanding         cardiorenal syndromes and selection of patients for novel therapeutic approaches.
authors.affiliation: Department of Internal Medicine, Cardiology Section, Santa Maria alle Scotte Hospital, Siena, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Palazzuoli
authors.forename: Matteo
authors.initials: M
authors.lastname: Beltrami
authors.forename: Savina
authors.initials: S
authors.lastname: Nodari
authors.forename: Peter A
authors.initials: PA
authors.lastname: McCullough
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
mesh_terms: D015415:Biomarkers / Q000032:analysis; D059347:Cardio-Renal Syndrome / Q000401:mortality* / Q000503:physiopathology* / Q000628:therapy*; D002986:Clinical Trials as Topic; D006801:Humans; D011379:Prognosis; D012084:Renin-Angiotensin System / Q000502:physiology; D012307:Risk Factors; D013564:Sympathetic Nervous System / Q000503:physiopathology
chemical_list: D015415:Biomarkers