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Pathophysiology of the cardiorenal syndromes: executive summary from the Eleventh Consensus Conference of the Acute Dialysis Quality Initiative (ADQI)

Item Type:Article
Title:Pathophysiology of the cardiorenal syndromes: executive summary from the Eleventh Consensus Conference of the Acute Dialysis Quality Initiative (ADQI)
Creators Name:McCullough, P.A. and Kellum, J.A. and Haase, M. and Mueller, C. and Damman, K. and Murray, P.T. and Cruz, D. and House, A.A. and Schmidt-Ott, K.M. and Vescovo, G. and Bagshaw, S.M. and Hoste, E.A. and Briguori, C. and Braam, B. and Chawla, L.S. and Costanzo, M.R. and Tumlin, J.A. and Herzog, C.A. and Mehta, R.L. and Rabb, H. and Shaw, A.D. and Singbartl, K. and Ronco, C.
Abstract:Cardiorenal syndromes (CRS) have been recently classified into five distinct entities, each with different major pathophysiologic mechanisms. CRS type 1 most commonly occurs in the setting of acutely decompensated heart failure where approximately 25% of patients develop a rise in serum creatinine and a reduction of urine output after the first several doses of intravenous diuretics. Altered cardiac and renal hemodynamics are believed to be the most important determinants of CRS type 1. CRS type 2 is the hastened progression of chronic kidney disease (CKD) in the setting of chronic heart failure. Accelerated renal cell apoptosis and replacement fibrosis is considered to be the dominant mechanism. CRS type 3 is acutely decompensated heart failure after acute kidney injury from inflammatory, toxic, or ischemic insults. This syndrome is precipitated by salt and water overload, acute uremic myocyte dysfunction, and neurohormonal dysregulation. CRS type 4 is manifested by the acceleration of the progression of chronic heart failure in the setting of CKD. Cardiac myocyte dysfunction and fibrosis, so-called 'CKD cardiomyopathy', is believed to be the predominant pathophysiologic mechanism. Type 5 CRS is simultaneous acute cardiac and renal injury in the setting of an overwhelming systemic insult such as sepsis. In this scenario, the predominant pathophysiological disturbance is microcirculatory dysfunction as a result of acutely abnormal immune cell signaling, catecholamine cellular toxicity, and enzymatic activation which result in simultaneous organ injury often extending beyond both the heart and the kidneys. This paper will summarize these and other key findings from an international consensus conference on the spectrum of pathophysiologic mechanisms at work in the CRS.
Keywords:Cardiac Myocytes, Cardio-Renal Syndrome, Heart Failure, Hemodynamics, Renal Dialysis
Source:Blood Purification
ISSN:0253-5068
Publisher:Karger (Switzerland)
Volume:37
Number:Suppl 2
Page Range:2-13
Date:31 July 2014
Official Publication:https://doi.org/10.1159/000361059

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