Perspective on cardiorenal syndrome

The heart and kidneys share responsibility for maintaining hemodynamic stability and end-organ perfusion through a close relationship that controls volume status, cardiac output, and vascular tone. Cardiorenal syndrome is generally defined as a pathophysiologic disorder of the heart and kidneys whereby acute or chronic dysfunction of one organ induces acute or chronic dysfunction of the other. Five subtypes of cardiorenal syndrome are recognized, use of which helps characterize group of patients and provide the rationale for specific management strategies. Underperfusion from reduced cardiac output, venous congestion, increased intra-abdominal pressure, and activation of neurohormonal mediator play significant role in the pathophysiology of the disease. Treatment is often empirical and includes use of diuretics, natriuretic peptides, renin-angiotensin-aldosterone system inhibitors, inotropes, and ultrafiltration.