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Classification of Cardiorenal Syndrome
Objectives
The chapter will:
- 1.
Provide an overview of cardiorenal syndrome (CRS) classification.
- 2.
Briefly review cardiorenal syndromes definitions and clinical implications.
- 3.
Focus on main pathophysiologic features of each CRS.
Large numbers of hospitalized patients have various degrees of heart and kidney dysfunction ; primary disease of the heart or kidney often involves dysfunction of or injury to the other. Based on this organ cross-talk, the term cardiorenal syndrome (CRS) was proposed. Although CRS usually was referred to as an interruption of kidney function after heart injury, it is now clearly established that it can describe negative effects of an impaired renal function on the heart and circulation.
Definition of Cardiorenal Syndrome
According to the recent definition proposed by the consensus conference of the Acute Dialysis Quality Initiative Group, the term cardiorenal syndrome has been used to define different clinical conditions in which heart and kidney dysfunction overlap. The heart and kidney are involved in basic physiology, and their functions are linked closely. Although the heart provides nourishing and oxygen-rich fluids to all body areas, the kidney is accountable for providing fluid, electrolytes, and acid-base homeostasis together with neurohormonal activity (erythropoietin synthesis and vitamin D activation).
A clear classification of CRS is crucial as its correct application is required, offering an exciting challenge for nephrologists and cardiologists, who have to contaminate their own fields of applications. An effective classification of CRS has been proposed in a consensus conference by the Acute Dialysis Quality Group in 2008 ( Table 110.1 ). This classification essentially divides CRS in two main groups, cardiorenal and renocardiac CRS, on the basis of primum movens of disease (cardiac or renal). Cardiorenal and renocardiac CRS then are divided into acute and chronic, according to disease's onset. Type – 5 CRS integrates all cardiorenal involvement induced by systemic disease.
TABLE 110.1
Classification of Cardiorenal Syndrome
| TYPE1 | DENOMINATION | DESCRIPTION | EXAMPLE |
|---|---|---|---|
| 1 | Acute cardiorenal | Heart failure leading to AKD | Acute coronary syndrome leading to acute heart and kidney failure |
| 2 | Chronic cardiorenal | Chronic heart failure leading to kidney failure | Chronic heart failure |
| 3 | Acute nephrocardiac | AKD leading to acute heart failure | Uremic cardiomyopathy AKD-related |
| 4 | Chronic nephrocardiac | Chronic kidney disease leading to heart failure | Left ventricular hypertrophy and diastolic heart failure resulting from kidney failure |
| 5 | Secondary | Systemic disease leading to heart and kidney failure | Sepsis, vasculitis, diabetes mellitus |
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