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International Journal of Nephrology
Volume 2011 (2011), Article ID 283137, 10 pages
http://dx.doi.org/10.4061/2011/283137
Review Article

The Cardiorenal Syndrome: Making the Connection

Division of Nephrology, Tufts Medical Center, 800 Washington Street, P.O. 391, Boston, MA 02111, USA

Received 18 August 2010; Accepted 17 September 2010

Academic Editor: Mitchell H. Rosner

Copyright © 2011 Gautham Viswanathan and Scott Gilbert. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The heart and the kidneys share responsibility for maintaining hemodynamic stability and end-organ perfusion. Connections between these organs ensure that subtle physiologic changes in one system are tempered by compensation in the other through a variety of pathways and mediators. In the setting of underlying heart disease or chronic kidney disease, the capacity of each organ to respond to perturbation caused by the other may become compromised. This has recently led to the characterization of the cardiorenal syndrome (CRS). This review will primarily focus on CRS type 1 where acute decompensated heart failure (ADHF) results in activation of hemodynamic and neurohormonal factors leading to an acute drop in the glomerular filtration rate and the development of acute kidney injury. We will examine the scope and impact of this problem, the pathophysiology associated with this relationship, including underperfuson and venous congestion, diagnostic tools for earlier detection, and therapeutic interventions to prevent and treat this complication.