Pliquett Rainer U
Department of Nephrology and Diabetology, Carl-Thiem Hospital Cottbus, 03048 Cottbus, Germany.
Department of Internal Medicine, University Hospital Halle, Martin-Luther University Halle-Wittenbeg, 06108 Halle (Saale), Germany.
J Clin Med. 2022 May 20;11(10):2896. doi: 10.3390/jcm11102896.
Cardiorenal syndrome (CRS) is defined as progressive, combined cardiac and renal dysfunction. In this mini review, a historical note on CRS is presented, the pathomechanisms and clinical hallmarks of both chronic heart failure and chronic kidney disease are discussed, and an updated classification of CRS is proposed. The current consensus classification relies on the assumed etiology and the course of the disease, i.e., acute or chronic CRS. Five types are described: type-I CRS presenting as acute cardiac failure leading to acute renal failure; type-II CRS presenting as chronic cardiac failure leading to chronic renal failure; type-III CRS presenting as acute kidney injury aggravating heart failure; type-IV CRS presenting as chronic kidney failure aggravating heart failure; and type-V CRS presenting as concurrent, chronic cardiac and renal failure. For an updated classification, information on the presence or absence of valvular heart disease and on the presence of hyper- or hypovolemia is added. Thus, CRS is specified as "acute" (type-I, type-III or type-V CRS) or "chronic" (type-II, type-IV or type-V) CRS, as "valvular" or "nonvalvular" CRS, and as "hyper-" or "hypovolemia-associated" CRS if euvolemia is absent. To enable the use of this updated classification, validation studies are mandated.
心肾综合征（CRS）被定义为进行性的心脏和肾脏联合功能障碍。在这篇小型综述中，介绍了CRS的历史沿革，讨论了慢性心力衰竭和慢性肾脏病的病理机制及临床特征，并提出了CRS的更新分类。目前的共识分类依据假定的病因和疾病进程，即急性或慢性CRS。描述了五种类型：I型CRS表现为急性心力衰竭导致急性肾衰竭；II型CRS表现为慢性心力衰竭导致慢性肾衰竭；III型CRS表现为急性肾损伤加重心力衰竭；IV型CRS表现为慢性肾衰竭加重心力衰竭；V型CRS表现为同时存在的慢性心脏和肾衰竭。对于更新分类，增加了关于是否存在瓣膜性心脏病以及是否存在血容量过多或过少的信息。因此，CRS被明确分为“急性”（I型、III型或V型CRS）或“慢性”（II型、IV型或V型）CRS，“瓣膜性”或“非瓣膜性”CRS，以及在不存在血容量正常的情况下分为“血容量过多相关”或“血容量过少相关”CRS。为了能够使用这种更新分类，必须进行验证研究。
