Section of Heart Failure and Cardiac Transplantation Medicine, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Heart. 2010 Feb;96(4):255-60. doi: 10.1136/hrt.2009.166256. Epub 2009 Apr 27.
Worsening renal function during treatment of acute decompensated heart failure (ADHF) often complicates the treatment course of heart failure. Furthermore, the development of worsening renal function is a strong independent predictor of long-term adverse outcomes. Sometimes referred to as 'cardiorenal syndrome,' the definition varies widely, and the overall understanding of pathogenesis is limited. This is probably owing to the lack of precision and characterisation of renal compromise during treatment of heart failure. Traditionally, the predominant cause has been attributed to impairment of cardiac output and relative underfilling of arterial perfusion. Emerging data have led to a resurgence of interest in the importance of venous congestion and elevated intra-abdominal pressure rather than confining it to impaired forward cardiac output as the primary driver of renal impairment. These revived concepts may support the role of novel renal-sparing approaches to salt and water removal and renal preservation, but better ways to distinguish haemodynamic versus other nephrotoxic aetiologies are needed.
在急性失代偿性心力衰竭（ADHF）的治疗过程中，肾功能恶化常常使心力衰竭的治疗过程复杂化。此外，肾功能恶化的发展是长期不良预后的一个强有力的独立预测因子。有时被称为“心肾综合征”，其定义差异很大，对发病机制的整体理解有限。这可能是由于在心力衰竭治疗过程中缺乏对肾脏损害的精确性和特征性描述。传统上，主要原因归因于心输出量受损和动脉灌注相对不足。新出现的数据使人们重新关注静脉充血和腹内压升高的重要性，而不是将其局限于受损的前向心输出量作为导致肾脏损害的主要原因。这些新出现的概念可能支持对盐和水去除以及肾脏保护采用新型保肾方法，但需要更好的方法来区分血流动力学与其他肾毒性病因。
