Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha (K.P.P.).
Division of Cardiovascular Medicine, Department of Internal Medicine (K.K.), Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
Circ Res. 2022 May 13;130(10):1601-1617. doi: 10.1161/CIRCRESAHA.122.319989. Epub 2022 May 12.
The maintenance of cardiovascular homeostasis is highly dependent on tightly controlled interactions between the heart and the kidneys. Therefore, it is not surprising that a dysfunction in one organ affects the other. This interlinking relationship is aptly demonstrated in the cardiorenal syndrome. The characteristics of the cardiorenal syndrome state include alterations in neurohumoral drive, autonomic reflexes, and fluid balance. The evidence suggests that several factors contribute to these alterations. These may include peripheral and central nervous system abnormalities. However, accumulating evidence from animals with experimental models of congestive heart failure and renal dysfunction as well as humans with the cardiorenal syndrome suggests that alterations in neural pathways, from and to the kidneys and the heart, including the central nervous system are involved in regulating sympathetic outflow and may be critically important in the alterations in neurohumoral drive, autonomic reflexes, and fluid balance commonly observed in the cardiorenal syndrome. This review focuses on studies implicating neural pathways, particularly the afferent and efferent signals from the heart and the kidneys integrating at the level of the paraventricular nucleus in the hypothalamus to alter neurohumoral drive, autonomic pathways, and fluid balance. Further, it explores the potential mechanisms of action for the known beneficial use of various medications or potential novel therapeutic manipulations for the treatment of the cardiorenal syndrome. A comprehensive understanding of these mechanisms will enhance our ability to treat cardiorenal conditions and their cardiovascular complications more efficaciously and thoroughly.
心血管稳态的维持高度依赖于心脏和肾脏之间的紧密控制相互作用。因此，一个器官的功能障碍会影响另一个器官也就不足为奇了。这种相互关联的关系在心脏肾综合征中得到了很好的体现。心脏肾综合征状态的特征包括神经激素驱动、自主反射和液体平衡的改变。有证据表明，有几个因素导致了这些变化。这些因素可能包括外周和中枢神经系统异常。然而，来自充血性心力衰竭和肾功能障碍的实验动物模型以及心脏肾综合征患者的累积证据表明，肾脏和心脏的神经通路的改变，包括中枢神经系统，参与调节交感传出，并可能在心脏肾综合征中常见的神经激素驱动、自主反射和液体平衡的改变中至关重要。这篇综述重点介绍了涉及神经通路的研究，特别是来自心脏和肾脏的传入和传出信号，在下丘脑室旁核水平整合，以改变神经激素驱动、自主途径和液体平衡。此外，它还探讨了已知有益的各种药物的作用机制或潜在的新的治疗干预措施，用于治疗心脏肾综合征。全面了解这些机制将提高我们更有效地和全面地治疗心脏肾疾病及其心血管并发症的能力。
