title: Cardiorenal syndrome--current understanding and future perspectives.
abstract: Combined cardiac and renal dysfunction has gained considerable attention. Hypotheses about its pathogenesis have been formulated, albeit based on a relatively small body of experimental studies, and a clinical classification system has been proposed. Cardiorenal syndrome, as presently defined, comprises a heterogeneous group of acute and chronic clinical conditions, in which the failure of one organ (heart or kidney) initiates or aggravates failure of the other. This conceptual framework, however, has two major drawbacks: the first is that, despite worldwide interest, universally accepted definitions of cardiorenal syndrome are lacking and characterization of heart and kidney failure is not uniform. This lack of consistency hampers experimental studies on mechanisms of the disease. The second is that, although progress has been made in developing hypotheses for the pathogenesis of cardiorenal syndrome, these initiatives are at an impasse. No hierarchy has been identified in the myriad of haemodynamic and non-haemodynamic factors mediating cardiorenal syndrome. This Review discusses current understanding of cardiorenal syndrome and provides a roadmap for further studies in this field. Ultimately, discussion of the definition and characterization issues and of the lack of organization among pathogenetic factors is hoped to contribute to further advancement of this complex field.
authors.affiliation: Department of Medicine, Division of Nephrology, University of Alberta, 11-132 Clinical Sciences Building, Edmonton, AB T6G 2G3, Canada.
authors.forename: Branko
authors.initials: B
authors.lastname: Braam
authors.affiliation: Department of Nephrology and Hypertension, University Medical Centre, PO Box 85500, 3508 GA, Utrecht, Netherlands.
authors.forename: Jaap A
authors.initials: JA
authors.lastname: Joles
authors.affiliation: Department of Medicine, Division of Nephrology, University of Alberta, 11-132 Clinical Sciences Building, Edmonton, AB T6G 2G3, Canada.
authors.forename: Amir H
authors.initials: AH
authors.lastname: Danishwar
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Room 40.4.040, PO Box 30001, 9700 RB, Groningen, Netherlands.
authors.forename: Carlo A
authors.initials: CA
authors.lastname: Gaillard
mesh_terms: D059347:Cardio-Renal Syndrome / Q000175:diagnosis* / Q000453:epidemiology*; D018450:Disease Progression; D014943:Global Health; D006334:Heart Function Tests / Q000379:methods*; D006801:Humans; D007677:Kidney Function Tests / Q000379:methods*; D009017:Morbidity; D011379:Prognosis; D012720:Severity of Illness Index