Cardiorenal Syndrome An Unsolved Clinical Problem英文文献资料.docVIP

SAGE-HindawiAccesstoResearch InternationalJournalofNephrology Volume2011,ArticleID913029,6pages doi:10.4061/2011/913029 ReviewArticle CardiorenalSyndrome:AnUnsolvedClinicalProblem PaulaMart′?nez-Santos andIsidreVilacosta 1 2 1 2 HospitalUniversitarioFundaci′onAlcorc′on,Av.Budapestno.1,Alcorc′on,28922Madrid,Spain DepartmentodeCardiologia,HospitalCl′?nicoSanCarlosProfesorMart′?nLagos,28040Madrid,Spain CorrespondenceshouldbeaddressedtoPaulaMart′?nez-Santos,paulams1@ Received20August2010;Revised28January2011;Accepted28March2011 AcademicEditor:AnjayRastogi Copyright?2011P.Mart′?nez-SantosandI.Vilacosta. This is an open access article distributed under the Creative Commons AttributionLicense,whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkis properlycited. Theclinicalrelevanceofthebidirectionalcross-talkbetweenheartandkidneyisincreasinglyrecognized.However,theoptimal approachtothemanagementofkidneydysfunctioninheartfailureremainsunclear.Thepurposeofthisarticleistooutlinethe mostplausiblepathophysiologictheoriesthatattempttoexplaintherenalimpairmentinacuteandchronicheartfailure,andto reviewthecurrenttreatmentstrategiesforthesesituations. 1.Introduction of renal function (WRF) in the setting of chronic heart failure (CHF). Both, acute and progressive development of renal dysfunction in patients with heart failure, have been associated with independently worse outcomes com- pared with preserved renal function [3–13]. Therefore, a precise understanding of the pathophysiology of this syndromeisneededtoprovidetherationaleformanagement strategies. Heartandkidneyareinextricablylinkedtomaintainhome- ostasis. Communication between these two organs occurs atmultiplelevelsincludingthesympatheticnervoussystem (SNS), the renin-angiotensin-aldosterone system (RAAS), the antidiuretic hormone, endothelin, or the natriuretic peptides.Thedysfunctionofoneofthemcontributestothe dysfunctionoftheother;renaldysfunctionimpairscard