Ronco Claudio, Di Lullo Luca
International Renal Research Institute (IRRIV), S. Bortolo Hospital, Vicenza, Italy.
Department of Nephrology and Dialysis, L. Parodi-Delfino Hospital, Colleferro, Italy.
Kidney Dis (Basel). 2017 Jan;2(4):151-163. doi: 10.1159/000448749. Epub 2016 Sep 10.
It is well established that a large number of hospitalized patients present various degrees of heart and kidney dysfunction; primary disease of the heart or kidney often involves dysfunction or injury to the other.
Based on above-cited organ cross-talk, the term cardiorenal syndrome (CRS) was proposed. Although CRS was usually referred to as abruption of kidney function following heart injury, it is now clearly established that it can describe negative effects of an impaired renal function on the heart and circulation. The historical lack of clear syndrome definition and complexity of diseases contributed to a waste of precious time especially concerning diagnosis and therapeutic strategies. The effective classification of CRS proposed in a Consensus Conference by the Acute Dialysis Quality Group essentially divides CRS into two main groups, cardiorenal and renocardiac CRS, on the basis of primum movens of disease (cardiac or renal); both cardiorenal and renocardiac CRS are then divided into acute and chronic according to disease onset. Type 5 CRS integrates all cardiorenal involvement induced by systemic disease.
Prevalence and incidence data show a widespread increase of CRS also due to an increasing incidence of acute and chronic cardiovascular disease, such as acute decompensated heart failure, arterial hypertension and valvular heart disease. Patients with chronic kidney disease present various degrees of cardiovascular involvement especially due to chronic inflammatory status, volume and pressure overload and secondary hyperparathyroidism leading to a higher incidence of calcific heart disease. The following review will focus on the main aspects (epidemiology, risk factors, diagnostic tools and protocols, therapeutic approaches) of CRS in Western countries (Europe and United States).
大量住院患者存在不同程度的心肾功能障碍，这已得到充分证实；心脏或肾脏的原发性疾病常常累及另一器官的功能或造成损伤。
基于上述器官间的相互作用，提出了心肾综合征（CRS）这一术语。尽管CRS通常被认为是心脏损伤后肾功能的突然恶化，但现在已经明确，它也可以描述肾功能受损对心脏和循环系统的负面影响。以往缺乏明确的综合征定义以及疾病的复杂性，导致宝贵时间的浪费，尤其是在诊断和治疗策略方面。急性透析质量组在一次共识会议上提出的CRS有效分类，基本上根据疾病的始发因素（心脏或肾脏）将CRS分为两个主要类别，即心肾型和肾心型CRS；然后根据疾病发作情况，将心肾型和肾心型CRS再分为急性和慢性。5型CRS涵盖了由全身性疾病引起的所有心肾受累情况。
患病率和发病率数据显示，由于急性和慢性心血管疾病（如急性失代偿性心力衰竭、动脉高血压和心脏瓣膜病）发病率的上升，CRS的发病率也普遍增加。慢性肾脏病患者存在不同程度的心血管受累情况，尤其是由于慢性炎症状态、容量和压力超负荷以及继发性甲状旁腺功能亢进，导致钙化性心脏病的发病率更高。以下综述将聚焦于西方国家（欧洲和美国）CRS的主要方面（流行病学、危险因素、诊断工具和方案、治疗方法）。
