Cardiorenal syndrome in heart failure: A cardiologist's perspective
Cardiorenal syndrome in heart failure: A cardiologist's perspective
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DOI：
10.1016/s0828-282x(08)71027-4
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发表时间：
2008-07-01
影响因子：
6.2
通讯作者：
Liu, Peter P.
中科院分区：
文献类型：
--
作者：
Liu, Peter P.
心衰最重要的合并症之一是肾功能不全。估计肾小球滤过率降低是心血管死亡率和并发症的有效预测因子。另一方面，心衰恶化或急性失代偿性心衰会加速肾功能恶化，即所谓的心肾综合征。危险因素包括高血压、糖尿病、老年、既往心脏或肾功能衰竭史。心肾综合征的病理生理学涉及肾内血流动力学、经肾灌注压和全身神经激素因素。心肾综合征患者的临床管理包括利尿剂抵抗的挑战，这可能涉及纠正根本原因，联合利尿剂或利尿剂输注。改善结果的关键是优化已证实的心力衰竭治疗方法。血管扩张剂治疗是目前主要的治疗方法。奈西立肽，或重组b型利钠肽，因其在心肾综合征中的作用而引起争议。然而，越来越多的数据显示，低剂量似乎对肾脏有保护作用。其他最近的策略包括超滤，抗利尿激素拮抗剂和腺苷拮抗剂。所有这些新的方式都承诺更快的体积清除，但它们对生存或肾功能保存的最终影响目前尚不清楚。由于这些患者的复杂性质和折衷的结果，重要的是心脏科医生、肾病科医生和内科医生共同努力保护心肾综合征患者，并利用现有的最佳证据进行管理。
One of the most important comorbidities in heart failure is renal dysfunction. Diminished estimated glomerular filtration rate is a potent predictor of cardiovascular mortality an complications. On the other hand, worsening heart failure or acute decompensated heart failure can accelerate worsening of renal function - the so-called cardiorenal syndrome. Risk factors include by hypertension, diabetes, elderly age, and prior history of heart or renal failure., P The pathophysiology of the cardiorenal syndrome involves intrarenal hemodynamics, transrenal perfusion pressure and systemic neurohormonal factors. Clinical management of the patient with cardiorenal syndrome includes the challenge of diuretic resistance, which may involve correcting the underlying cause, combination diuretics or diuretic infusions. The key to improved outcome is the optimization of proven heart failure therapies. The use of vasodilator therapy is the current mainstay of treatment. Nesiritide, or recombinant B-type natriuretic peptide, has courted controversy regarding its role in cardiorenal syndrome. However, data are emerging that low doses appear to be renal-protective. Other more recent strategies include ultrafiltration, vasopressin antagonists and adenosine antagonists. All of these newer modalities promise more rapid volume removal, but their ultimate impact on survival or preservation of renal function is unknown at the present time.Because of the complex nature of these patients, and the compromised outcome, it is important that cardiologists, nephrologists and internists all work together toward the common goat of protecting the patient with cardiorenal syndrome, and use the best available evidence for management.