Cardiorenal Syndrome and Heart Failure-Challenges and Opportunities.
Cardiorenal Syndrome and Heart Failure-Challenges and Opportunities.
复制标题
心脏综合征和心力衰竭挑战和机会。
DOI：
10.1016/j.cjca.2019.04.002
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发表时间：
2019-09
影响因子：
6.2
通讯作者：
Oudit, Gavin Y.
中科院分区：
文献类型：
--
作者：
Yogasundaram, Haran;Chappell, Mark C.;Braam, Branko;Oudit, Gavin Y.
心肾综合征（CRS）描述心脏和肾脏同时出现的双向功能障碍，其中一个器官启动、延续和/或加速另一个器官的衰退。CRS常见于心力衰竭，普遍预示预后恶化。尽管有如此沉重的疾病负担，但CRS的适当诊断和分类仍然存在问题。除了肾灌注减少和肾静脉压升高的血流动力学驱动因素外，肾素-血管紧张素-醛固酮系统的诱导、交感神经系统的刺激、一氧化氮和活性氧平衡的破坏以及炎症都与CRS的发病机制有关。药物治疗心力衰竭包括肾素-血管紧张素-醛固酮系统抑制和β-肾上腺素能阻断可以钝化这些有害的过程。肾血管性疾病可加速CRS的进展。容量超载和利尿剂抵抗是常见的，使CRS的治疗复杂化。在使用利尿剂治疗心力衰竭和CRS的患者中，如果实现了临床去充血，肌酐恶化与预后恶化无关。辅助治疗通常需要在管理容量超载的CRS，但这些治疗的证据是有限的。贫血和缺铁与CRS有重要关系，并可能加重心脏和肾脏功能的下降。终末期心脏和/或肾脏疾病预后特别差，治疗选择有限。总的来说，肾功能恶化与死亡率显著增加相关。尽管CRS领域取得了进展，但CRS的多个病理生理和临床方面仍需要进一步研究，以最终制定有效的治疗方案。
Cardiorenal syndromes (CRS) describe concomitant bidirectional dysfunction of the heart and kidneys in which 1 organ initiates, perpetuates, and/or accelerates decline of the other. CRS are common in heart failure and universally portend worsened prognosis. Despite this heavy disease burden, the appropriate diagnosis and classification of CRS remains problematic. In addition to the hemodynamic drivers of decreased renal perfusion and increased renal vein pressure, induction of the renin-angiotensin-aldosterone system, stimulation of the sympathetic nervous system, disruption of balance between nitric oxide and reactive oxygen species, and inflammation are implicated in the pathogenesis of CRS. Medical therapy of heart failure including renin-angiotensin-aldosterone system inhibition and β-adrenergic blockade can blunt these deleterious processes. Renovascular disease can accelerate the progression of CRS. Volume overload and diuretic resistance are common and complicate the management of CRS. In heart failure and CRS being treated with diuretics, worsening creatinine is not associated with worsened outcome if clinical decongestion is achieved. Adjunctive therapy is often required in the management of volume overload in CRS, but evidence for these therapies is limited. Anemia and iron deficiency are importantly associated with CRS and might amplify decline of cardiac and renal function. End-stage cardiac and/or renal disease represents an especially poor prognosis with limited therapeutic options. Overall, worsening renal function is associated with significantly increased mortality. Despite progress in the area of CRS, there are still multiple pathophysiological and clinical aspects of CRS that need further research to eventually develop effective therapeutic options.
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影响因子：
4.6
作者：
Colombo, Paolo C.;Ganda, Anjali;Lin, Jeffrey;Onat, Duygu;Harxhi, Ante;Iyasere, Julia E.;Uriel, Nir;Cotter, Gad
通讯作者：
Cotter, Gad
影响因子：
6.1
作者：
Bagshaw, Sean M.;Cruz, Dinna N.;Ronco, Claudio
通讯作者：
Ronco, Claudio
DOI：
10.1152/ajpregu.00727.2009
发表时间：
2010-03-01
影响因子：
2.8
作者：
Bongartz, L. G.;Braam, B.;Joles, J. A.
通讯作者：
Joles, J. A.
影响因子：
120.7
作者：
Chen, Horng H.;Anstrom, Kevin J.;Givertz, Michael M.;Stevenson, Lynne W.;Semigran, Marc J.;Goldsmith, Steven R.;Bart, Bradley A.;Bull, David A.;Stehlik, Josef;LeWinter, Martin M.;Konstam, Marvin A.;Huggins, Gordon S.;Rouleau, Jean L.;O'Meara, Eileen;Tang, W. H. Wilson;Starling, Randall C.;Butler, Javed;Deswal, Anita;Felker, G. Michael;O'Connor, Christopher M.;Bonita, Raphael E.;Margulies, Kenneth B.;Cappola, Thomas P.;Ofili, Elizabeth O.;Mann, Douglas L.;Davila-Roman, Victor G.;McNulty, Steven E.;Borlaug, Barry A.;Velazquez, Eric J.;Lee, Kerry L.;Shah, Monica R.;Hernandez, Adrian F.;Braunwald, Eugene;Redfield, Margaret M.
通讯作者：
Redfield, Margaret M.
影响因子：
5.4
作者：
Brisco-Bacik, Meredith A.;ter Maaten, Jozine M.;Testani, Jeffrey M.
通讯作者：
Testani, Jeffrey M.