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  • Review Article
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Cardiorenal syndrome—current understanding and future perspectives

Nature Reviews Nephrology volume 10, pages 48–55 (2014)Cite this article

Subjects

Key Points

  • Interactions between the heart and kidney form the basis of cardiorenal syndrome, which is a heterogeneous and complex clinical entity associated with substantial morbidity and mortality

  • Precise clinical characterization and classification of cardiorenal syndrome has not yet been performed

  • The factors that mediate connections between the heart and the kidney and their complex interactions must be clarified in vitro and in experimental models before clinical applications are sought

  • Iron metabolism and erythrocyte turnover are likely to be central to the pathophysiology of cardiorenal syndrome

Abstract

Combined cardiac and renal dysfunction has gained considerable attention. Hypotheses about its pathogenesis have been formulated, albeit based on a relatively small body of experimental studies, and a clinical classification system has been proposed. Cardiorenal syndrome, as presently defined, comprises a heterogeneous group of acute and chronic clinical conditions, in which the failure of one organ (heart or kidney) initiates or aggravates failure of the other. This conceptual framework, however, has two major drawbacks: the first is that, despite worldwide interest, universally accepted definitions of cardiorenal syndrome are lacking and characterization of heart and kidney failure is not uniform. This lack of consistency hampers experimental studies on mechanisms of the disease. The second is that, although progress has been made in developing hypotheses for the pathogenesis of cardiorenal syndrome, these initiatives are at an impasse. No hierarchy has been identified in the myriad of haemodynamic and non-haemodynamic factors mediating cardiorenal syndrome. This Review discusses current understanding of cardiorenal syndrome and provides a roadmap for further studies in this field. Ultimately, discussion of the definition and characterization issues and of the lack of organization among pathogenetic factors is hoped to contribute to further advancement of this complex field.

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Figure 1: Evolution in the understanding of a clinical condition.
Figure 2: IL-6 is one of the many factors implicated in cardiorenal interactions.
Figure 3: Proposed 'roadmap' for future studies of cardiorenal syndrome.

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Acknowledgements

B. Braam is a Heart and Stroke Foundation of Canada New Investigator and a Mazankowski Alberta Heart Institute member.

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Authors and Affiliations

  1. Department of Medicine, Division of Nephrology, University of Alberta, 11–132 Clinical Sciences Building, Edmonton, T6G 2G3, AB, Canada

    Branko Braam & Amir H. Danishwar

  2. Department of Nephrology and Hypertension, University Medical Centre, PO Box 85500, Utrecht, 3508 GA, Netherlands

    Jaap A. Joles

  3. Division of Nephrology, Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Room 40.4.040, PO Box 30001, Groningen, 9700 RB, Netherlands

    Carlo A. Gaillard

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B. Braam and A. H. Danishwar researched the data for the article and wrote the manuscript. B. Braam, J. A. Joles and C. A. Gaillard contributed substantially to discussions of the article's content. All four authors contributed to review and/or editing of the manuscript before submission.

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Braam, B., Joles, J., Danishwar, A. et al. Cardiorenal syndrome—current understanding and future perspectives. Nat Rev Nephrol 10, 48–55 (2014). https://doi.org/10.1038/nrneph.2013.250

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