Gil Paloma, Justo Soledad, Castilla M Angeles, Criado Carolina, Caramelo Carlos
Nephrology and Medicine Departments, Jiménez Díaz Foundation, University Autónoma, Queen Sofia Institue of Nephrology Research, Reyes Católicos 2, 28040 Madrid, Spain.
Curr Opin Nephrol Hypertens. 2005 Sep;14(5):442-7. doi: 10.1097/01.mnh.0000170753.41279.70.
This review focuses on the pathophysiology and treatment of an increasingly common entity, cardio-renal insufficiency. Cardio-renal insufficiency is more than a simultaneous cardiac and renal disease. Patients with this condition live within a fragile equilibrium challenged by the interaction of profibrogenic, atherosclerotic, neurohumoral, and other less known factors. Regarding therapy, the avoidance of oscillations between overfilled-decompensated and emptied-overtreated states becomes of critical importance. Particular focus should be paid to personalized treatment, adjusted according to heart and kidney reserve, the predictable complications of therapy, prevention of decompensations, simple measures-based follow-up and alternative procedures.
Recent studies have established the important repercussions of unbalanced renal function on cardiovascular prognosis. In the heart failure setting, trials involving extensive cohorts of ageing or comorbidity-affected patients are presently under way. Special attention should be paid to recognize the presence of renal failure coexisting with heart failure, especially in patients with deceivingly near-normal plasma creatinine. Formulae to predict creatinine clearance are being increasingly incorporated into daily clinical practice. Disturbed renal function is an underappreciated prognostic factor in heart failure, and renal failure is frequently viewed as a relative contraindication to some proven efficacious therapies.
Cardio-renal insufficiency is an emerging entity, with affected individuals surviving with extreme degrees of simultaneous heart failure and renal failure. Management of the condition is an intellectually demanding process. Crucial to this management is extensive medical expertise and an in-depth understanding of the particular renal, haemodynamic and internal milieu equilibrium of the patients.
本综述聚焦于一种日益常见的病症——心肾综合征的病理生理学及治疗。心肾综合征并非简单的心脏和肾脏疾病同时存在。患有这种病症的患者处于一种脆弱的平衡状态，受到促纤维化、动脉粥样硬化、神经体液及其他一些尚不明确的因素相互作用的挑战。在治疗方面，避免患者在过度充血 - 失代偿状态与血容量不足 - 过度治疗状态之间波动至关重要。应特别关注个性化治疗，根据心脏和肾脏储备、可预测的治疗并发症、预防失代偿、基于简单措施的随访以及替代治疗手段进行调整。
近期研究已证实肾功能失衡对心血管预后具有重要影响。在心力衰竭领域，目前正在进行涉及大量老年或合并症患者队列的试验。应特别注意识别与心力衰竭并存的肾衰竭情况，尤其是血浆肌酐看似接近正常的患者。预测肌酐清除率的公式正越来越多地应用于日常临床实践。肾功能紊乱是心力衰竭中一个未得到充分认识的预后因素，肾衰竭常被视为一些已证实有效的治疗的相对禁忌证。
心肾综合征是一种新出现的病症，患病个体同时患有严重的心力衰竭和肾衰竭。对该病症的管理是一个需要高智力水平的过程。这种管理的关键在于广泛的医学专业知识以及对患者特定的肾脏、血流动力学和内环境平衡的深入理解。
