Leventoğlu Emre, Kavgacı Akif, Örün Utku Arman, Büyükkaragöz Bahar
Konya City Hospital, Department of Pediatric Nephrology, Konya, Turkey.
Etlik City Hospital, Department of Pediatric Cardiology, Ankara, Turkey.
Cardiorenal Med. 2025;15(1):358-373. doi: 10.1159/000545791. Epub 2025 Apr 25.
The interaction between the heart and kidneys involves complex mechanisms, leading to a clinical condition known as cardiorenal syndrome (CRS), where dysfunction in one organ leads to impairment of the other. This syndrome can be acute or chronic, affecting both organs simultaneously.
In 2008, the Acute Dialysis Quality Group classified CRS into two main categories: cardiorenal CRS and renocardiac CRS, based on the primary organ affected. Cardiorenal CRS includes two subtypes where heart failure causes kidney injury (types 1 and 2), while renocardiac CRS (types 3 and 4) refers to kidney injury leading to cardiac dysfunction, either from acute kidney injury or chronic kidney disease. Type 5 CRS is termed as secondary CRS which involves both organ dysfunction due to an acute systemic disease, such as sepsis, infections, or chronic conditions like diabetes mellitus. This review examines the cardiovascular involvement in various nephrological diseases commonly seen in clinical practice, with a focus on types 3-5 CRS in children from a nephrology perspective.
CRS is common in pediatric patients with cardiac, renal, or systemic conditions and poses a significant risk of mortality. The lack of longitudinal studies or specific biomarkers for the diagnosis, treatment, and follow-up of CRS in children is evident. Aspects such as the development of new biomarkers, ongoing research into neurohormonal mechanisms, meta-analyses, and introduction of algorithms for the follow-up period may reshape patient management. Specific diagnostic tools or therapeutic interventions for CRS management in children should be implemented. Collaborative efforts among pediatricians, cardiologists, and nephrologists are essential for developing effective treatments. Large-scale studies are needed to better understand CRS and develop targeted therapies to improve outcomes for pediatric patients, reducing morbidity and mortality.
心脏与肾脏之间的相互作用涉及复杂机制，导致一种称为心肾综合征（CRS）的临床状况，即一个器官的功能障碍会导致另一个器官受损。这种综合征可分为急性或慢性，同时影响两个器官。
2008年，急性透析质量组根据受影响的主要器官将CRS分为两大类：心肾CRS和肾心CRS。心肾CRS包括两个亚型，即心力衰竭导致肾损伤（1型和2型），而肾心CRS（3型和4型）是指肾损伤导致心脏功能障碍，其原因可以是急性肾损伤或慢性肾病。5型CRS被称为继发性CRS，涉及由于急性全身性疾病（如脓毒症、感染）或糖尿病等慢性疾病导致的两个器官功能障碍。本综述从肾脏病学角度研究了临床实践中常见的各种肾脏病中的心血管受累情况，重点关注儿童3-5型CRS。
CRS在患有心脏、肾脏或全身性疾病的儿科患者中很常见，并且具有显著的死亡风险。显然，缺乏针对儿童CRS诊断、治疗和随访的纵向研究或特定生物标志物。新生物标志物的开发、对神经激素机制的持续研究、荟萃分析以及随访期算法的引入等方面可能会重塑患者管理。应实施针对儿童CRS管理的特定诊断工具或治疗干预措施。儿科医生、心脏病专家和肾脏病专家之间的合作对于开发有效治疗方法至关重要。需要进行大规模研究，以更好地了解CRS并开发针对性疗法，改善儿科患者的治疗效果，降低发病率和死亡率。
