Department of Internal Medicine, Cardiology Section, Santa Maria alle Scotte Hospital, Siena, Italy.
Rev Cardiovasc Med. 2011;12(4):186-99. doi: 10.3909/ricm0581.
Renal impairment in heart failure (HF) patients has been increasingly recognized as an independent risk factor for morbidity and mortality. In the most recent European and American guidelines for HF management, renal dysfunction was considered an index of poor prognosis independent of the presence of other traditionally investigated risk factors. Different mechanisms appear to be implicated in worsening renal function in patients with acute decompensated HF (ADHF) in contrast to chronic HF. In patients with acute ADHF, renal impairment has been attributed to renal hypoperfusion due to reduced cardiac output and decreased systemic blood pressure. In these patients, neurohormonal activation of the renin-angiotensin and sympathetic nervous systems plays a key role. In chronic and clinically stable HF, other mechanisms, including microvascular damage, oxidative stress, inflammation, and fibrosis, lead to a reduced number of functioning nephrons. Differentiating transient functional changes in renal filtration and acute renal tubular injury with loss of functioning nephrons is a critical step in understanding cardiorenal syndromes and selection of patients for novel therapeutic approaches.
心力衰竭（HF）患者的肾功能损害已日益被认为是发病率和死亡率的独立危险因素。在最近的欧洲和美国心力衰竭管理指南中，肾功能障碍被认为是预后不良的指标，独立于其他传统研究的危险因素。在急性失代偿性心力衰竭（ADHF）患者中，与慢性心力衰竭相比，不同的机制似乎与肾功能恶化有关。在急性 ADHF 患者中，由于心输出量降低和全身血压降低导致的肾脏低灌注导致了肾功能损害。在这些患者中，肾素-血管紧张素和交感神经系统的神经激素激活起着关键作用。在慢性和临床稳定的心力衰竭中，包括微血管损伤、氧化应激、炎症和纤维化在内的其他机制导致功能肾单位数量减少。区分肾功能滤过的短暂功能性变化和丧失功能肾单位的急性肾小管损伤是理解心肾综合征和选择新型治疗方法患者的关键步骤。
