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CARDIORENAL SYNDROME

Cardiorenal syndrome (CRS) is a condition in which the kidneys do not function properly due to cardiac dysfunction or the structure and function of the heart is impaired due to kidney problems.

Types

Cardiorenal syndrome is classified into five types as detailed below:

 

Type I – Acute cardiorenal syndrome

It is a sudden worsening of heart function which leads to acute kidney injury. The heart conditions which contribute to such dysfunction of kidneys include:

  • Cardiogenic shock
  • Acute coronary syndrome (ACS)
  • Acutely decompensated heart failure (ADHF)
  • Low-flow syndrome following cardiac surgery

Sometimes this type of condition arises due to the use of contrast medium for diagnostic testing of acute cardiac conditions.

Type II – Chronic cardiorenal syndrome

It indicates long-term abnormalities of the heart function which can lead to permanent damage to the kidney. Such heart conditions include:

  • Atrial fibrillation (a type of abnormal heart rhythm)
  • Chronic ischemic heart disease (which results from a reduced blood flow to the heart)
  • Constrictive pericarditis
  • Chronic heart failure
  • Congenital cyanotic heart disease

Type III – Acute renocardiac syndrome

It is a sudden worsening of kidney function which leads to acute heart disorders. Such kidney conditions include:

  • Rhabdomyolysis (skeletal muscle breakdown)
  • Acute nephrotic syndrome
  • Drug induced acute kidney disease
  • Acute renal failure after a major surgery

This type of CRS may also result with the use of contrast medium for diagnostic testing of acute kidney problems.

Type IV – Chronic renocardiac syndrome

This type of CRS occurs due to long-term kidney diseases which lead to an increased risk of cardiovascular events such as:

  • Acute heart failure
  • Myocardial infarction
  • Left ventricular hypertrophy
  • Cardiac remodeling

Type V – Secondary cardiorenal syndrome

In this type of CRS both the heart and kidney functions are affected due to certain medical conditions such as:

  • Diabetes mellitus
  • Hypertension
  • Sepsis
  • Lupus (SLE)
  • Amyloidosis
  • Sarcoidosis

Causes

The exact cause of cardiorenal syndrome is not known. However, the possible mechanisms are as follows:

  • Decrease in the blood circulation to the kidneys may cause a decrease in the efficiency of the heart to pump blood
  • Activation of several neurohormones which cause constriction of the blood vessels
  • Increase in venous pressure which affects the veins in the kidneys

 

Consequences

Due to the co-existence of heart and kidney problems, the following consequences occur:

  • There is an increased risk of death in patients with heart failure if there is a decrease in glomerular filtration rate (GFR) or decrease in kidney function
  • Patients with chronic kidney disease (CKD) are at higher risk of heart failure and atherosclerotic cardiovascular disease

Diagnosis

If a patient has cardiovascular problems, then the doctor critically evaluates for the underlying kidney problems and vice versa.

These include:

  • Physical examination
  • Collection of the history of the patient which includes medical, medication and family history
  • Laboratory tests which include blood tests, urine tests
  • Imaging tests such as CT scan and MRI
  • Biopsy (microscopic examination of the suspected tissue)

Treatment

It is challenging to treat cardiorenal syndrome. Treatment options for CRS include:

  • Angiotensin converting enzyme (ACE) inhibitors
  • Angiotensin receptor II blockers (ARBs)
  • Loop diuretics or water pills

During the therapy, heart and kidneys are regularly monitored to check for their efficient functioning.

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