Therapeutic approach to cardiorenal syndrome

1 “Victor Papilian” Faculty of Medicine 2 Sibiu County Emergency Clinical Hospital, “Victor Papilian” Faculty of Medicine 3 Sibiu County Emergency Clinical Hospital Contact address: Minodora Teodoru, Cardiology Clinic, Sibiu County Emergency Clinical Hospital, 2-4 Corneliu Coposu Bvd., Sibiu E-mail: [email protected] These types of CRS are in fact five different syndromes from an epidemiologic, clinical and therapeutic point of view. Often different components, from the different types of CRS, interact with one another. In this article we will refer mostly to the first two types (cardiorenal syndromes). Renal dysfunction associated with heart failure leads to a severe prognostic. According to some studies, this association increases the mortality rate in these patients with up to 20%2-4. The physiopathological mechanisms which intermediate the disequilibrium present in CRS is presented in Figure 1, according to the Guyton model5. The profile of patients at risk of developing CRS is presented in Table 2. In daily practice, the diagnosis of CRS is based on the existence of an association between heart failure and the onset, or exacerbation, of a renal dysfunction. Current diagnostic elements include the increase of serum creatinine levels by more than 30% compared to initial levels, reducing the diuresis with adequate doses of diuretics, the aggravation of heart failure signs and symptoms, or the absence of regression of hemodynaDEfInItIon anD ImpoRtanCE Cardiorenal syndrome (CRS) is an individual pathology rather than a simple association between heart and renal failure. CRS develops a different, complex physiopathology, requiring a special treatment, which has not been studied sufficiently. CRS represents “the heart and kidneys’ physiopathological modifications, when the acute or chronic dysfunction of one organ determines the failure of the other” as it was defined by Ronco at the World Nephrology Congress in 20081. CRS was classified in 5 types according to the organ which generated the lesion and to its debut (acute or chronic). This classification is presented in Table 11. abstract: Cardiorenal syndrome is often described in heart failure patients and it represents the deterioration of renal function in the context of heart failure. When it occurs, the prognosis of these patients is affected by the combination of these pathologies. The treatment for cardiorenal syndrome should be applied individually in order to achieve the improvement of the patient’s clinical status, the preservation of the heart and kidney function and a better outcome. Along with traditional therapies (diuretics, inotropes), which often develop resistance, the beneficial effect of new therapeutic options (ultrafiltration, vasopressin and adenosine antagonists) is being evaluated in different trials.