Cardiorenal Syndrome in Acute Heart Failure Syndromes英文文献资料.docVIP

SAGE-HindawiAccesstoResearch InternationalJournalofNephrology Volume2011,ArticleID293938,10pages doi:10.4061/2011/293938 ResearchArticle CardiorenalSyndromeinAcuteHeartFailureSyndromes MohammadSarraf andRobertW.Schrier 1 2 1 2 UniversityofMinnesota,USA UniversityofColorado,USA CorrespondenceshouldbeaddressedtoRobertW.Schrier,robert.schrier@ Received22November2010;Accepted9January2011 AcademicEditor:AlejandroMart′?n-Malo Copyright?2011M.SarrafandR.W.Schrier.ThisisanopenaccessarticledistributedundertheCreativeCommonsAttribution License,whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperly cited. Impairedcardiacfunctionleadstoactivationoftheneurohumoralaxis,sodiumandwaterretention,congestionandultimately impaired kidney function. This sequence of events has been termed the Cardiorenal Syndrome. This is di?erent from the increaseincardiovascularcomplicationswhichoccurwithprimarykidneydisease,thatis,theso-calledRenocardiacSyndrome. ThepresentreviewdiscussesthepathogenesisoftheCardiorenalSyndromefollowedbythebene?tsandpotentialdeleterious e?ectsofpharmacologicalagentsthathavebeenusedinthissetting.Theagentsdiscussedarediuretics,aquaretics,natriuretic peptides, vasodilators, inotropes and adenosine α1 receptor antagonists. The potential role of ultra?ltration is also brie?y discussed. 1.Introduction 2.Pathophysiology Patients with acute heart failure syndromes (AHFS) are usuallyadmittedbecauseofseveresystemiccongestionthat frequently presents with dyspnea. Known as the hallmark of AHFS, congestion is mainly due to pulmonary venous hypertension (World Health Organization type 2). These patients may also present with low cardiac output and/or systemichypotension.Thishasrangedfrom2%[1]to7.7% [2]to29%[3]dependingontheseries.Dyspneaisthemost commonsymptominthesepatientsthatimpliesanelevated pulmonary venous pressure that is often accompanied by increasedcentralvenouspressure(CVP)and/orperipheral edema. Theref