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Diagnosis of type-1 cardiorenal syndrome (CRS) focuses on laboratory findings and ultrasonography and/or second-level radiologic assays.
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Type-2 CRS is characterized by onset of chronic kidney disease (CKD) in patients with heart failure, but coexistence of cardiovascular disease and CKD is not enough to propose a type-2 CRS diagnosis.
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Type-3 CRS represents a typical scenario after cardiovascular surgery or contrast exposure; prevention is a key point in managing this kind of CRS.
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Because type-4
Cardiorenal Syndrome
Section snippets
Key points
Type-1 CRS
Type-1 CRS occurs in about 25% of patients hospitalized for acute decompensated heart failure (ADHF)2, 3; among these patients preexistent chronic kidney disease (CKD) is common, and contributes to acute kidney injury (AKI) in 60% of all cases studied. AKI can be considered an independent mortality risk factor in patients with ADHF, including those with ST-elevated myocardial infarction and/or reduced left ventricular ejection fraction (LVEF).4
Type-2 CRS
CRS type 2 is characterized by chronic abnormalities in cardiac function leading to kidney injury or dysfunction; the temporal relationship between heart and kidney disease is an epidemiologic and pathophysiologic aspect of the definition itself. Literature data show that chronic heart and kidney disease often coexist, but large cohort studies have assessed the onset of one disease (eg, chronic HF), subsequently describing the prevalence of the other (CKD).49, 50 It is difficult to establish
Type-3 CRS
Type-3 CRS, also defined as acute renocardiac syndrome, occurs when AKI contributes to and/or precipitates the development of acute cardiac injury. Many pathophysiologic causes of AKI can predispose to development of CRS type 3 (Boxes 1 and 2).
AKI may directly or indirectly produce an acute cardiac event; many experimental data suggest that cardiac damage con be supported by inflammatory status, oxidative stress, and secretion of neurohormones following AKI.86, 87
AKI can be associated with
Type-4 CRS
Type-4 CRS, also defined as chronic renocardiac syndrome, is characterized by cardiovascular involvement in patients affected by CKD at any stage according to the National Kidney Foundation (NKF) classification.
The prevalence of end-stage renal disease (ESRD) is still increasing and represents a worldwide epidemiologic problem.124 The latest data from the United States estimate that up to 13% of the population may present with CKD at any stage of disease.
It is well established that renal
Type-5 CRS
Type-5 CRS is a recently defined clinical syndrome, and complete epidemiologic data are still lacking. Type-5 CRS occurs when the heart and kidney are involved simultaneously. Literature data underline that type-5 CRS encompasses many clinical syndromes such as sepsis, hepatorenal syndrome, and drug toxicity, in which the heart and kidney are involved secondarily to basic disease.166 The temporal sequence that involves the heart and kidney depends on the underlying disease.
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