Fedele Francesco, Karason Kristjan, Matskeplishvili Simon
Department of Cardiovascular, Respiratory, Anesthesiology, Nephrology and Geriatric Science, School of Cardiology, La Sapienza University of Rome, Rome, Italy.
Departments of Cardiology and Transplantation, Sahlgrenska University Hospital, Gothenburg, Sweden.
Eur Heart J Suppl. 2017 Mar;19(Suppl C):C22-C28. doi: 10.1093/eurheartj/sux002. Epub 2017 Mar 8.
Pathological interplay between the heart and kidneys-also known as cardio-renal syndrome (CRS)-is frequently encountered in heart failure and is linked to worse prognosis and quality of life. Drug therapies for this complex situation may include nitroprusside or the recombinant B-type natriuretic peptide nesiritide for patients with acute CRS with normal or high blood pressure, and inotropes or inodilators for patients with acute CRS with low blood pressure. Clinical data for a renal-protective action of levosimendan are suggestive, and meta-analysis data obtained in a range of low-output states are consistent with a levosimendan-induced benefit. Evidence of favourable organ-specific effects of levosimendan, including pre-glomerular vasodilation and increased renal artery diameter and renal blood flow, were collected both in preclinical and clinical studies. Larger randomized controlled trials are however needed to confirm the renal effects of levosimendan in various clinical settings.
心脏与肾脏之间的病理相互作用——也称为心肾综合征（CRS）——在心力衰竭中经常出现，并且与更差的预后和生活质量相关。针对这种复杂情况的药物治疗可能包括，对于血压正常或升高的急性CRS患者使用硝普钠或重组B型利钠肽奈西立肽，对于血压低的急性CRS患者使用正性肌力药或血管扩张剂。左西孟旦肾脏保护作用的临床数据具有提示性，在一系列低心输出量状态下获得的荟萃分析数据与左西孟旦诱导的益处一致。在临床前和临床研究中均收集到了左西孟旦对器官有特定有益作用的证据，包括肾小球前血管舒张、肾动脉直径增加和肾血流量增加。然而，需要更大规模的随机对照试验来证实左西孟旦在各种临床环境中的肾脏效应。
