Boudoulas Konstantinos Dean, Triposkiadis Filippos, Parissis John, Butler Javed, Boudoulas Harisios
Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA.
Department of Cardiology, Larissa University Hospital, Larissa, Greece.
Prog Cardiovasc Dis. 2017 May-Jun;59(6):636-648. doi: 10.1016/j.pcad.2016.12.003. Epub 2016 Dec 16.
The heart and the kidney are of utmost importance for the maintenance of cardiovascular (CV) homeostasis. In healthy subjects, hemodynamic changes in either organ may affect hemodynamics of the other organ. This interaction is fine-tuned by neurohumoral activity, including atrial natriuretic peptides, renin-angiotensin aldosterone system and sympathetic activity. Dysfunction or disease of one organ may initiate, accentuate, or precipitate dysfunction or disease state in the other organ, often leading to a vicious cycle. Further, the interaction between the heart and the kidney may occur in the setting of processes and diseases that may affect both organs simultaneously, such as advanced age, hypertension, diabetes mellitus, atherosclerosis, etc. In this regard, a stiff aorta that occurs with aging due to mechanical stress may independently initiate or precipitate dysfunction and disease in the heart and the kidney. All of these factors contribute to a high prevalence of coexistent CV and kidney disease, especially in the elderly. In advanced kidney disease, hemodynamic and neurohumoral homeostasis are lost, volume and pressure overload may coexist, and the elimination of certain pharmacologic agents may be substantially impaired. Thus, coexistence of CV and kidney disease complicates diagnosis, propagates pathophysiology, adversely affects prognosis, and hinders management.
心脏和肾脏对于维持心血管（CV）稳态至关重要。在健康受试者中，任一器官的血流动力学变化都可能影响另一器官的血流动力学。这种相互作用通过神经体液活动进行微调，包括心房利钠肽、肾素 - 血管紧张素 - 醛固酮系统和交感神经活动。一个器官的功能障碍或疾病可能引发、加重或促成另一器官的功能障碍或疾病状态，常常导致恶性循环。此外，心脏和肾脏之间的相互作用可能发生在可能同时影响两个器官的过程和疾病背景下，如高龄、高血压、糖尿病、动脉粥样硬化等。在这方面，由于机械应力导致的随年龄增长而出现的主动脉僵硬可能独立引发或促成心脏和肾脏的功能障碍及疾病。所有这些因素导致心血管疾病和肾脏疾病并存的患病率很高，尤其是在老年人中。在晚期肾脏疾病中，血流动力学和神经体液稳态丧失，容量和压力超负荷可能并存，某些药物的清除可能会严重受损。因此，心血管疾病和肾脏疾病并存使诊断复杂化，加剧病理生理过程，对预后产生不利影响，并阻碍治疗。
