Cardio-Renal Syndrome Type 5: Epidemiology, Pathophysiology, and Treatment

Soni, Sachin; Ronco, Claudio; Pophale, Rupesh; Bhansali, Ashish S.; Nagarik, Amit P; Barnela, Shriganesh R.; Saboo, Sonali S.; Raman, Anuradha

doi:10.1016/j.semnephrol.2011.11.007

Cited by 25 publications

(23 citation statements)

References 61 publications

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“…CRS type 5 is also the most frequent class in our cohort, probably due to many clinical situations in which both organs are targeted simultaneously by systemic illnesses (such as sepsis, vasculitis, autoimmune diseases, etc. ), either acute or chronic, which are very often present in internal medicine wards [15]. Consequently, infectious diseases were more often present in CRS type 5.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Clinical Features of Patients with the Cardiorenal Syndrome Admitted to an Internal Medicine Ward

et al. 2014

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Background: Many patients admitted to a Department of Internal Medicine have different degrees of heart and kidney dysfunction. Mortality, morbidity and cost of care greatly increase when cardiac and renal diseases coexist. Methods: A retrospective cohort study was conducted on 1,087 patients admitted from December 2009 to December 2012 to evaluate the prevalence of the cardiorenal syndrome (CRS) and clinical features. Results: Out of 1,087 patients discharged from our unit during the study period, 190 (17.5%) were diagnosed as having CRS and classified into five types. CRS was more common in males (68.9%). CRS type 1 was associated with higher age (79.9 ± 8.9 years) and accounted for 61.5% of all deaths (p < 0.001), representing a risk factor for mortality (OR 4.23, 95% CI 1.8-10). Congestive heart failure was significantly different among the five CRS types (p < 0.0001) with a greater frequency in type 1 patients. Infectious diseases were more frequent in CRS types 1, 3 and 5 (p < 0.05). Pneumonia presented a statistically higher frequency in CRS types 1 and 5 compared to other classes (p < 0.01), and community-acquired infections were statistically more frequent in CRS types 1 and 5 (p < 0.05). The distribution of community-acquired pneumonia was different among the classes (p < 0.01) with a higher frequency in CRS types 1, 3 and 5. Conclusion: CRS is a condition that is more frequently observed in the clinical practice. The identification of predisposing trigger factors, such as infectious diseases, particularly in the elderly, plays a key role in reducing morbidity and mortality. An early recognition can be useful to optimize therapy, encourage a multidisciplinary approach and prevent complications.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Clinical Features of Patients with the Cardiorenal Syndrome Admitted to an Internal Medicine Ward

et al. 2014

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“…Although this subtype does not have a primary and secondary organ dysfunction, situations do arise where both organs simultaneously are targeted by systemic illnesses, the prototype being acute sepsis [59]. Sepsis is common and its incidence is increasing, with a mortality estimated between 20 and 60% [60].…”

Section: Resultsmentioning

confidence: 99%

Pathophysiology of the Cardiorenal Syndromes: Executive Summary from the Eleventh Consensus Conference of the Acute Dialysis Quality Initiative (ADQI)

et al. 2014

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Cardiorenal syndromes (CRS) have been recently classified into five distinct entities, each with different major pathophysiologic mechanisms. CRS type 1 most commonly occurs in the setting of acutely decompensated heart failure where approximately 25% of patients develop a rise in serum creatinine and a reduction of urine output after the first several doses of intravenous diuretics. Altered cardiac and renal hemodynamics are believed to be the most important determinants of CRS type 1. CRS type 2 is the hastened progression of chronic kidney disease (CKD) in the setting of chronic heart failure. Accelerated renal cell apoptosis and replacement fibrosis is considered to be the dominant mechanism. CRS type 3 is acutely decompensated heart failure after acute kidney injury from inflammatory, toxic, or ischemic insults. This syndrome is precipitated by salt and water overload, acute uremic myocyte dysfunction, and neurohormonal dysregulation. CRS type 4 is manifested by the acceleration of the progression of chronic heart failure in the setting of CKD. Cardiac myocyte dysfunction and fibrosis, so-called ‘CKD cardiomyopathy', is believed to be the predominant pathophysiologic mechanism. Type 5 CRS is simultaneous acute cardiac and renal injury in the setting of an overwhelming systemic insult such as sepsis. In this scenario, the predominant pathophysiological disturbance is microcirculatory dysfunction as a result of acutely abnormal immune cell signaling, catecholamine cellular toxicity, and enzymatic activation which result in simultaneous organ injury often extending beyond both the heart and the kidneys. This paper will summarize these and other key findings from an international consensus conference on the spectrum of pathophysiologic mechanisms at work in the CRS.

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“…Приблизительно у половины пациентов с СПК выяв-ляются признаки тромботической микроангиопатии (ТМА) [19]. Возможно развитие острого кардиоренального синдрома (1-го, 3-го или 5-го типа), проявляющегося оте-ком легких, застойной сердечной недостаточностью, оли-го-или анурией [20]. Редко диагноз СПК ассоциирован с диффузным геморрагическим альвеолитом и ТМА [21].…”

Section: нефропатии связанные со склеродермиейunclassified

Current Views on the Heterogeneity of Renal Involvements in Patients With Systemic Sclerosis

Гордеев¹,

Захарова²,

Мутовина³

et al. 2015

rsp

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Cardio-Renal Syndrome Type 5: Epidemiology, Pathophysiology, and Treatment

Cited by 25 publications

References 61 publications

Prevalence and Clinical Features of Patients with the Cardiorenal Syndrome Admitted to an Internal Medicine Ward

Prevalence and Clinical Features of Patients with the Cardiorenal Syndrome Admitted to an Internal Medicine Ward

Pathophysiology of the Cardiorenal Syndromes: Executive Summary from the Eleventh Consensus Conference of the Acute Dialysis Quality Initiative (ADQI)

Current Views on the Heterogeneity of Renal Involvements in Patients With Systemic Sclerosis

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