Aronson Doron
Department of Cardiology, Rambam Medical Center and the Rappaport Research Institute, Technion, Israel Institute of Technology, Bat Galim, Haifa, Israel.
Expert Rev Cardiovasc Ther. 2012 Feb;10(2):177-89. doi: 10.1586/erc.11.193.
Cardiorenal syndrome (CRS) commonly occurs during treatment of acute decompensated heart failure (ADHF) and is associated with poor clinical outcome. The pathophysiology of CRS entails a complex interaction between hemodynamic alterations, including reduced renal perfusion, increased venous pressure and activation of multiple neurohormonal systems. Attempts to effectively treat congestion while preserving renal function in ADHF are often met with limited clinical success and often require therapeutic decisions that reflect a compromise between potential benefits and harm. At present, there is no evidence-based intervention specifically targeted at renal function. Recent Phase III randomized trials, using novel agents in patients with ADHF, have largely failed to demonstrate any benefits of therapy on renal and clinical outcomes. Early diagnosis of CRS using novel markers of tubular injury may allow for timely interventions and attenuate progression. Future studies are needed to further elucidate the pathophysiology of this complex syndrome and identify new potential targets for effective evidence-based treatments.
心肾综合征（CRS）常见于急性失代偿性心力衰竭（ADHF）的治疗过程中，且与不良临床结局相关。CRS的病理生理学涉及血流动力学改变之间的复杂相互作用，包括肾灌注减少、静脉压升高以及多个神经激素系统的激活。在ADHF中，在保留肾功能的同时有效治疗充血的尝试往往在临床上取得有限的成功，并常常需要做出反映潜在益处和危害之间权衡的治疗决策。目前，尚无专门针对肾功能的循证干预措施。近期针对ADHF患者使用新型药物的III期随机试验，在很大程度上未能证明治疗对肾脏及临床结局有任何益处。使用肾小管损伤新标志物对CRS进行早期诊断，可能有助于及时干预并减缓疾病进展。需要开展进一步研究，以进一步阐明这一复杂综合征的病理生理学，并确定有效循证治疗的新潜在靶点。
