the cardiorenal syndrome making the connectioncardiorenal综合症进行连接.pdfVIP

SAGE-Hindawi Access to Research International Journal of Nephrology Volume 2011, Article ID 283137, 10 pages doi:10.4061/2011/283137 Review Article The Cardiorenal Syndrome: Making the Connection Gautham Viswanathan and Scott Gilbert Division of Nephrology, Tufts Medical Center, 800 Washington Street, P.O. 391, Boston, MA 02111, USA Correspondence should be addressed to Scott Gilbert, sgilbert@ Received 18 August 2010; Accepted 17 September 2010 Academic Editor: Mitchell H. Rosner Copyright © 2011 G. Viswanathan and S. Gilbert. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The heart and the kidneys share responsibility for maintaining hemodynamic stability and end-organ perfusion. Connections between these organs ensure that subtle physiologic changes in one system are tempered by compensation in the other through a variety of pathways and mediators. In the setting of underlying heart disease or chronic kidney disease, the capacity of each organ to respond to perturbation caused by the other may become compromised. This has recently led to the characterization of the cardiorenal syndrome (CRS). This review will primarily focus on CRS type 1 where acute decompensated heart failure (ADHF) results in activation of hemodynamic and neurohormonal factors leading to an acute drop in the glomerular filtration rate and the development of acute kidney injury. We will examine the scope and impact of this problem, the pathophysiology associated with this relationship, including underperfuson and venous congestion, diagnostic tools for earlier detection, and therapeutic interventions to pr