Kes Petar, Basić-Jukić Nikolina, Jurić Ivana, Basić-Kes Vanja
Zavod za dijalizu, Klinicki bolnicki centar Zagreb, Hrvatska.
Acta Med Croatica. 2008;62 Suppl 1:21-31.
The pathophysiological condition, in which combined cardiac and renal dysfunction amplifies a progression in the failure of the individual organ, has been denoted as severe cardiorenal syndrome (SCRS). An interactive network of cardiorenal connectors, i.e., the renin-angiotensin system (RAS), nitric oxide (NO) and reactive oxygen species (ROS) balance, the sympathetic nervous system (SNS), and inflammation, has been proposed as the cornerstones of the pathophysiology of SCRS. Because erythropoietin (Epo) production declinesin chronic renal failure (CRF) and Epo sensitivity might decrease by the cardiorenalconnectors in patients with the SCRS, it is not surprising thatanaemia is a commonly occurring state coinciding with CRF and chronic heart failure (CHF). Epo treatment in patients with SCRS acts via haematopoietic effects, but also may intervenes in the vicious circle of cardiorenal connectors with subsequent deteriorating effects on cardiac, renal, and vascular function. It appears that regular Epo treatment in anaemic patients with diminished renal function improves cardiac performance, delays the progression of kidney disease, and may be of clinical benefit even to patients suffering from CHF with relatively mild anaemia. Despite growing evidence about Epo having positive effects on both renal and cardiac function, little is known about the underlying mechanisms of action.
心脏和肾脏功能障碍共同加剧单个器官功能衰竭的病理生理状态,被称为严重心肾综合征(SCRS)。心肾连接因子的交互网络,即肾素-血管紧张素系统(RAS)、一氧化氮(NO)和活性氧(ROS)平衡、交感神经系统(SNS)以及炎症,被认为是SCRS病理生理学的基石。由于慢性肾衰竭(CRF)时促红细胞生成素(Epo)生成减少,且SCRS患者的心肾连接因子可能会降低Epo敏感性,因此贫血是CRF和慢性心力衰竭(CHF)常见的伴随状态也就不足为奇了。SCRS患者接受Epo治疗不仅通过造血作用发挥功效,还可能干预心肾连接因子的恶性循环,进而对心脏、肾脏和血管功能产生不良影响。肾功能减退的贫血患者定期接受Epo治疗似乎可改善心脏功能、延缓肾病进展,甚至可能对贫血相对较轻的CHF患者具有临床益处。尽管越来越多的证据表明Epo对肾脏和心脏功能均有积极作用,但其潜在作用机制却鲜为人知。