Ahmed M S, Wong C F, Pai P
Nephrology Department, Royal Liverpool University Hospital, Liverpool, UK.
Clin Nephrol. 2010 Oct;74(4):245-57. doi: 10.5414/cnp74245.
Patients with chronic kidney disease (CKD) are at high risk for major cardiovascular (CV) morbidity and mortality, especially when they range among the elderly. The co-existence of renal dysfunction is common in patients with chronic heart failure (CHF), and renal failure is among the strongest predictors of mortality in patients with heart failure. Approximately one-third of dialysis patients also suffer from heart failure. The term "cardiorenal syndrome" has been increasingly described in recent literature, as there is growing recognition of the frequent association of combined renal and cardiac dysfunction. The pathophysiology of the cardiorenal syndrome involves interrelated hemodynamic and neurohormonal mechanisms, including the sympathetic nervous system, the renin-angiotensin-aldosterone system, and endothelin and arginine vasopressin system activation. Recently, a new classification of cardiorenal syndrome has been proposed with five subtypes that reflect the pathophysiology, the bidirectional nature of heart and kidney interaction and the time-frame. The management of the cardiorenal syndrome remains a challenge in spite of the advances in medical therapy and novel agents. Novel agents such as B-type natriuretic peptide (BNP) derivative, endothelin antagonist, adenosine antagonist or vasopressin antagonist have been evaluated in randomized controlled trials, and their results are discussed in this review. Mechanical support like hemodialysis and ultrafiltration are found to be useful in acute cardiorenal syndrome. There has been renewed interest in b-blockers in chronic cardiorenal syndrome patients to prevent sudden cardiac death from arrhythmia. In this review, we discuss the evidence behind the definition, pathophysiology, new proposed classification and the various therapeutic measures available for acute cardiorenal syndrome as well as chronic cardiorenal syndrome.
慢性肾脏病（CKD）患者发生主要心血管（CV）疾病及死亡的风险很高，尤其是老年患者。肾功能不全在慢性心力衰竭（CHF）患者中很常见，肾衰竭是心力衰竭患者死亡的最强预测因素之一。约三分之一的透析患者也患有心力衰竭。近年来，“心肾综合征”这一术语在文献中越来越多地被提及，因为人们越来越认识到肾脏和心脏功能障碍常常合并存在。心肾综合征的病理生理学涉及相互关联的血流动力学和神经激素机制，包括交感神经系统、肾素 - 血管紧张素 - 醛固酮系统以及内皮素和精氨酸加压素系统的激活。最近，有人提出了心肾综合征的新分类，包括五个亚型，反映了病理生理学、心脏和肾脏相互作用的双向性质以及时间框架。尽管药物治疗和新型药物取得了进展，但心肾综合征的管理仍然是一个挑战。新型药物如B型利钠肽（BNP）衍生物、内皮素拮抗剂、腺苷拮抗剂或加压素拮抗剂已在随机对照试验中进行了评估，本文将讨论其结果。血液透析和超滤等机械支持在急性心肾综合征中被发现是有用的。对于慢性心肾综合征患者，人们对β受体阻滞剂预防心律失常导致的心源性猝死重新产生了兴趣。在这篇综述中，我们将讨论急性心肾综合征和慢性心肾综合征的定义、病理生理学、新提出的分类以及各种治疗措施背后的证据。
