Cardio-renal cachexia syndromes (CRCS)

Pathophysiological foundations of a vicious pathological circle

Mariantonietta Cicoira, Stefan D. Anker, Claudio Ronco

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Cardio-renal syndromes (CRS) are defined as disorders of the heart and kidney whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other. CRS have been classified into five categories, where types 2 and 4 represent respectively chronic cardio-renal and chronic reno-cardiac syndromes. In these conditions, the chronic disorder of either the heart or kidney has been shown to induce some degree of cachexia. At the same time, cachexia has been proposed as a possible mechanism contributing to the worsening of such pathological organ cross talk. Common pathogenetic mechanisms underlie body wasting in cachectic states of different chronic heart and kidney diseases. In these circumstances, a vicious circle could arise, in which cachexia associated with either heart failure or chronic kidney disease may contribute to further damage of the other organ. In chronic CRS, activation of the immune and neuroendocrine systems contributes to the genesis of cachexia, which in turn can negatively affect the heart and kidney function. In patients with cardiac sustained activation of the immune and neuroendocrine systems and oxidative stress, renal vascular resistance can increase and therefore impair renal perfusion, leading to worsening kidney function. Similarly, in renal cachexia, increased levels of pro-inflammatory cytokines can cause progressive left ventricular systolic dysfunction, myocardial cell death, endothelial dysfunction and increased myocardial fibrosis, with consequent impairment of the chronic reno-cardiac syndrome type 4. Thus, we speculate that the occurrence of different types of chronic CRS could represent a fundamental step in the genesis of cachexia, being renal and cardiac dysfunction closely related to the occurrence of systemic disorders leading to a final common pathway. Therefore, the heart and kidney and cachexia represent a triad causing a vicious circle that increases mortality and morbidity: In such circumstances, we may plausibly talk about cardio-renal cachexia syndrome. Complex interrelations may explain the transition from CRS to cachexia and from cachexia to CRS. Identification of the exact mechanisms occurring in these conditions could potentially help in preventing and treating this deadly combination.

Original languageEnglish
Pages (from-to)135-142
Number of pages8
JournalJournal of Cachexia, Sarcopenia and Muscle
Volume2
Issue number3
DOIs
Publication statusPublished - 2011

Fingerprint

Cardio-Renal Syndrome
Cachexia
Kidney
Neurosecretory Systems
Chronic Renal Insufficiency
Immune System
Left Ventricular Dysfunction
Vascular Resistance
Heart Diseases
Oxidative Stress
Fibrosis
Cell Death

Keywords

  • Cardio-renal syndromes
  • Heart
  • Kidney

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physiology (medical)

Cite this

Cardio-renal cachexia syndromes (CRCS) : Pathophysiological foundations of a vicious pathological circle. / Cicoira, Mariantonietta; Anker, Stefan D.; Ronco, Claudio.

In: Journal of Cachexia, Sarcopenia and Muscle, Vol. 2, No. 3, 2011, p. 135-142.

Research output: Contribution to journalArticle

Cicoira, Mariantonietta ; Anker, Stefan D. ; Ronco, Claudio. / Cardio-renal cachexia syndromes (CRCS) : Pathophysiological foundations of a vicious pathological circle. In: Journal of Cachexia, Sarcopenia and Muscle. 2011 ; Vol. 2, No. 3. pp. 135-142.
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