心脏肾脏综合征:分类、病理生理学、诊断和治疗策略:美国心脏协会的科学声明。
Cardiorenal Syndrome: Classification, Pathophysiology, Diagnosis, and Treatment Strategies: A Scientific Statement From the American Heart Association.
出版信息
Circulation. 2019 Apr 16;139(16):e840-e878. doi: 10.1161/CIR.0000000000000664.
Cardiorenal syndrome encompasses a spectrum of disorders involving both the heart and kidneys in which acute or chronic dysfunction in 1 organ may induce acute or chronic dysfunction in the other organ. It represents the confluence of heart-kidney interactions across several interfaces. These include the hemodynamic cross-talk between the failing heart and the response of the kidneys and vice versa, as well as alterations in neurohormonal markers and inflammatory molecular signatures characteristic of its clinical phenotypes. The mission of this scientific statement is to describe the epidemiology and pathogenesis of cardiorenal syndrome in the context of the continuously evolving nature of its clinicopathological description over the past decade. It also describes diagnostic and therapeutic strategies applicable to cardiorenal syndrome, summarizes cardiac-kidney interactions in special populations such as patients with diabetes mellitus and kidney transplant recipients, and emphasizes the role of palliative care in patients with cardiorenal syndrome. Finally, it outlines the need for a cardiorenal education track that will guide future cardiorenal trials and integrate the clinical and research needs of this important field in the future.
心脏肾脏综合征涵盖了一系列涉及心脏和肾脏的疾病,其中 1 个器官的急性或慢性功能障碍可能导致另 1 个器官的急性或慢性功能障碍。它代表了几个界面之间的心脏-肾脏相互作用的汇聚。这些包括衰竭心脏和肾脏反应之间的血流动力学串扰以及神经激素标志物和炎症分子特征的改变,这些都是其临床表型的特征。本科学声明的任务是描述过去十年中,在其临床病理描述不断演变的背景下,心脏肾脏综合征的流行病学和发病机制。它还描述了适用于心脏肾脏综合征的诊断和治疗策略,总结了糖尿病患者和肾移植受者等特殊人群中心脏-肾脏相互作用,并强调了姑息治疗在心脏肾脏综合征患者中的作用。最后,它概述了需要建立心脏肾脏教育轨道,以指导未来的心脏肾脏试验,并整合这个重要领域的临床和研究需求。