Cardiorenal syndrome

Cardiorenal syndrome (CRS) refers to the spectrum of disorders in which acute or chronic dysfunction of the heart or kidneys leads to acute or chronic dysfunction of the other.

The condition is classified into five subtypes based on the primary organ dysfunction and whether the disease process is acute or chronic. The heart and the kidneys maintain hemodynamic stability and organ perfusion through an intricate network. CRS results from a complex interplay of hemodynamic alterations, neurohormonal activation, inflammatory mediators, and endothelial dysfunction, all contributing to progressive organ injury. Cardiorenal syndrome is commonly associated with conditions such as heart failure, chronic kidney disease (CKD), acute kidney injury (AKI), and systemic hypertension.

Management of CRS primarily focuses on addressing the underlying cause while mitigating the complications associated with the syndrome. Since volume overload is a predominant feature in most patients, treatment typically involves fluid removal, primarily through loop diuretics, with thiazides as adjuncts for diuretic resistant cases. Ultrafiltration is reserved for refractory cases. Depending on the case, additional therapies such as ACE inhibitors, angiotensin II receptor blockers, mineralocorticoid receptor antagonists, and inotropes may be utilized. Despite available treatments, CRS remains associated with high morbidity and mortality.