Pathophysiological mechanisms and prognostic significance of renal functional impairment in cardiac patients

Massimo Volpe, Marco Testa

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Heart and kidney dysfunction are often associated, the primary disorder of one of these two organs being the cause of secondary involvement of the other. These interactions represent the pathophysiological basis of cardiorenal syndrome. Renal dysfunction is very common in heart failure patients, with a highly variable prevalence according to the subgroup of patients considered. The complex pathophysiologic interactions between heart and kidney are far from being completely understood. Several cardiorenal connectors, which represent the major players of the neurohumoral response in heart failure, have been identified. They act both through and independently from extracellular fluid volume control. Another mechanism, more recently taken into great consideration, is that of increased central venous pressure. Anemia, very frequent in both heart and renal failure, is most probably the third condition of this deadly syndrome, sometimes also called cardiorenal-anemia syndrome. In patients with heart failure, renal function has a powerful prognostic significance. This is true both in chronic heart failure over a long follow-up and in acutely decompensated heart failure for in-hospital mortality. In patients with advanced heart failure, baseline glomerular filtration rate has been reported to be even more powerful than left ventricular ejection fraction in predicting mortality. The prognostic meaning of worsening renal failure during hospitalization for acute decompensated heart failure is, on the contrary, less clear.

Original languageEnglish
Title of host publicationCardiorenal Syndrome: Mechanisms, Risk and Treatment
PublisherSpringer Milan
Pages189-203
Number of pages15
ISBN (Print)9788847014626
DOIs
Publication statusPublished - 2010

Keywords

  • Anemia
  • Cardiorenal syndrome
  • Central venous pressure
  • Extracellular fluid volume
  • Heart failure
  • Neurohumoral response
  • Pathophysiology
  • Prevalence
  • Prognosis
  • Renal impairment
  • Reninangiotensin-aldosterone system

ASJC Scopus subject areas

  • Medicine(all)

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