title: Cardiorenal Syndrome in Acute Heart Failure: Revisiting Paradigms.
abstract: Cardiorenal syndrome has been defined as the simultaneous dysfunction of both the heart and the kidney. Worsening renal function that occurs in patients with acute heart failure has been classified as cardiorenal syndrome type 1. In this setting, worsening renal function is a common finding and is due to complex, multifactorial, and not fully understood processes involving hemodynamic (renal arterial hypoperfusion and renal venous congestion) and nonhemodynamic factors. Traditionally, worsening renal function has been associated with worse outcomes, but recent findings have revealed mixed and heterogeneous results, perhaps suggesting that the same phenotype represents a diversity of pathophysiological and clinical situations. Interpreting the magnitude and chronology of renal changes together with baseline renal function, fluid overload status, and clinical response to therapy might help clinicians to unravel the clinical meaning of renal function changes that occur during an episode of heart failure decompensation. In this article, we critically review the contemporary evidence on the pathophysiology and clinical aspects of worsening renal function in acute heart failure.
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain. Electronic address: yulnunez@gmail.com.
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
authors.affiliation: Servicio de Cardiología, Hospital de Manises, Manises, Valencia, Spain.
authors.forename: Gema
authors.initials: G
authors.lastname: Miñana
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia, Valencia, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Santas
authors.affiliation: Departamento de Cardiología, Hospital Universitario de San Juan, Universidad Miguel Hernández, San Juan de Alicante, Alicante, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Bertomeu-González
mesh_terms: D000208:Acute Disease; D059347:Cardio-Renal Syndrome / Q000209:etiology* / Q000503:physiopathology; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans
keywords: Acute heart failure; Cardiorenal syndrome; Clinical implications; Empeoramiento de la función renal; Implicaciones clínicas; Insuficiencia cardiaca aguda; Síndrome cardiorrenal; Worsening renal function