title: Cardiorenal syndrome: pathophysiology and treatment.
abstract: CRS is a common problem in patients with advanced heart failure. Arterial underfilling with consequent neurohormonal activation, systemic and intrarenal vasoconstriction, and salt and water retention cause the main clinical features of CRS which include a progressive decline in renal function, worsening renal function during treatment of heart failure (HF) decompensation and resistance to loop diuretics. Impaired renal function in HF patients often reflects more advanced stages of cardiac failure, and thus is associated with a worse prognosis. However, a transient fall in glomerular filtration rate may be a result of successful treatment of congestion, and thereby might not be associated with decreased survival in HF patients. This review covers basic pathophysiological mechanisms underlying the CRS and current trends in practical approaches to treat these patients.
authors.affiliation: Department of Preventive and Emergency Cardiology, I.M.Setchenov's First Moscow State Medical University, 119992, 6 (1), Bolshaya Pirogovskaya str., Moscow, Russia. agishm@list.ru
authors.forename: Dmitry
authors.initials: D
authors.lastname: Shchekochikhin
authors.forename: Robert W
authors.initials: RW
authors.lastname: Schrier
authors.forename: JoAnn
authors.initials: J
authors.lastname: Lindenfeld
mesh_terms: D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D059347:Cardio-Renal Syndrome / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D006801:Humans; D011379:Prognosis; D014462:Ultrafiltration / Q000379:methods; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002316:Cardiotonic Agents; D004232:Diuretics; D014665:Vasodilator Agents