Cardiorenal Syndromes and Sepsis英文文献资料.docVIP

SAGE-HindawiAccesstoResearch InternationalJournalofNephrology Volume2011,ArticleID652967,8pages doi:10.4061/2011/652967 ReviewArticle CardiorenalSyndromesandSepsis C.Chelazzi,G.Villa,andA.R.DeGaudio SectionofAnesthesiologyandIntensiveCare,DepartmentofCriticalCare,UniversityofFlorence,PadiglioneClinicheChirurgiche, VialeMorgagni85,50134Florence,Italy CorrespondenceshouldbeaddressedtoC.Chelazzi,cosimochelazzi@ Received13September2010;Revised25January2011;Accepted28January2011 AcademicEditor:C.Ronco Copyright?2011C.Chelazzietal.ThisisanopenaccessarticledistributedundertheCreativeCommonsAttributionLicense, whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperlycited. The cardiorenal syndrome is a clinical and pathophysiological entity de?ned as the concomitant presence of renal and cardiovascular dysfunction. In patients with severe sepsis and septic shock, acute cardiovascular, and renal derangements are common,thatis,thesepticcardiorenalsyndrome.Theaimofthispaperistodescribethepathophysiologyandclinicalfeaturesof septiccardiorenalsyndromeinlightoftheactualclinicalandexperimentalevidence.Inparticular,theimportanceofsystemicand intrarenalendothelialdysfunction,alterationsofkidneyperfusion,andmyocardialfunction,organ“crosstalk”andubiquitous in?ammatoryinjuryhavebeenextensivelyreviewedinlightoftheirroleincardiorenalsyndromeetiology.Treatmentincludes earlyandtargetedoptimizationofhemodynamicstoreversesystemichypotensionandrestoreurinaryoutput.Incaseofpersistent renalimpairment,renalreplacementtherapymaybeusedtoremovecytokinesandrestorerenalfunction. 1.IntroductionandDe?nitions diorenalsyndrome.Cardiacandrenaldysfunctionsareoften partoftheclinicalpictureofseveresepsisandsepticshock [3].Followingclassi?cationofRonco,sepsismayrepresent anacutecauseofType5cardiorenalsyndrome[2]. Thecardiorenalsyndromes(CRSs)arerelativelynewclinical and pathophysiological entities which have been de?ned as the concomitant presence of renal and car