¨Também conhecida com síndrome da anemia cardiorrenal. É caracterizada por anormalidades crônicas na função cardíaca, levando à lesão ou disfunção renal. Um pior desempenho cardíaco na insuficiência cardíaca resulta em hipoperfusão renal, com subsequente ativação da via renina-angiotensina-aldosterona e do sistema nervoso simpático, que pode piorar ainda mais a função renal. A doença renal crônica e consequente uremia pode levar à regulação anormal da homeostase do cálcio nos miócitos e da função contrátil, atividade simpática aumentada, disfunção endotelial, disfunção microvascular e aterosclerose acelerada. A anemia está associada com alta mortalidade em todos os pacientes com insuficiência cardíaca, e reflete um estado avançado da doença. Ainda, é particularmente considerada um fator de risco independente de mobimortalidade em todas as SCRs. Para incluir a ampla gama de transtornos interrelacionados e para enfatizar a natureza bidirecional das interações cardiorrenais, a síndrome é classificada em 5 categorias distintas, sendo que em cada tipo reflete-se a doença primária mais provável e o tempo de evolução:
Tipo I. Síndrome cardiorrenal aguda: piora abrupta da função cardíaca (choque cardiogênico ou ICC agudamente descompensada) conduzindo à lesão renal aguda. Está presente em 30% a 50% dos pacientes hospitalizados com IC aguda. O critério para o diagnostico é o aumento da creatinina sérica ≥ 0,3 mg/dL ou uma elevação superior a 50% do valor admissional.
Tipo II. Síndrome cardiorrenal crônica: anormalidades crônicas na função cardíaca (ICC crônica) provocando doença renal crônica e potencialmente permanente.
Tipo III. Síndrome renocardíaca aguda: piora abrupta da função renal (isquemia renal aguda ou glomerulonefrite) acarretando doença cardíaca aguda (insuficiência cardíaca, arritmia, isquemia).
Tipo IV. Síndrome renocardíaca crônica: doença renal crônica primária (doença glomerular ou intersticial crônica) contribuindo para diminuição da função cardíaca, hipertrofia cardíaca e/ou aumento no risco de eventos cardiovasculares adversos.
Tipo V. Síndrome cardiorrenal secundária: presença de uma condição sistêmica (p,ex, sepse),produzindo disfunção cardíaca e renal simultânea.
Vários tratamentos têm sido propostos para tratar os vários tipos de síndromes cardiorrenais, agudas e crônicas.¨
■ Acute cardiorrenal syndrome: mechanisms and clinical implications
G S Thind, M Loehrke, J L Wilt
Cleveland Clinic Journal of Medicine 2018, vol 85 (3): 231-239
https://www.mdedge.com/ccjm/article/159320/cardiology/acute-cardiorenal-syndrome-mechanisms-and-clinical-implications
■ Is the mean platelet volume a predictive marker of a high in-hospital mortality of acute cardiorenal syndrome patients receiving continuous renal replacement therapy?
Junhui Li, Xiaohua Sheng, Dongsheng Cheng et al
Medicine (Baltimore) 2018 Jun; 97(25): e11180
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6023845/
■ Biomarkers in cardiorenal syndrome
Shihui Fu, Shaopan Zhao, Ping Ye, Leiming Luo
Biomed Res Int. 2018; 2018: 9617363
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859843/
■ Systemic inflammation in acute cardiorenal syndrome: an observational pilot study
Christoph Linhart, Christof Ulrich, Daniel Greinert, Stefanie Dambeck, Andreas Wienke, Matthias Girndt, Rainer U. Pliquett
ESC Heart Fail. 2018, vol 5(5): 920–930.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6165938/
■ Renal function monitoring in heart failure – What is the optimal frequency? A narrative review
Ahmed Al‐Naher, David Wright, Mark Alexander John Devonald, Munir Pirmohamed
Br J Clin Pharmacol. 2018, vol 84(1): 5–17
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5736847/
■ Worsening renal function and mortality in heart failure: causality or confounding?
Jeffrey M. Testani, Meredith A. Brisco-Bacik
Circ Heart Fail. 2017 Feb; 10(2): e003835
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5382499/
■ Síndrome cardiorrenal
Pereira-Rodriguez, Javier Elizecer et al.
Rev. Colomb. Cardiol., Dic 2017, vol.24, no.6, p.602-613
http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-56332017000600602&lng=en&nrm=iso
■ Síndrome Cardiorrenal Tipo 2: Um Forte Fator Prognóstico da Sobrevida
Salim, Arous et al
Int. J. Cardiovasc. Sci., Sept 2017, vol.30, no.5, p.425-432
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2359-56472017000500425&lng=en&nrm=iso&tlng=pt
■ The physiopathology of cardiorenal syndrome: a review of the potential contributions of inflammation
J G Kingma, D Simard, J R Rouleau, B Drolet
J Cardiovasc Dev Dis 2017, vol 4 (4): 21
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5753122/
■ Pharmacological approaches to cardio-renal syndrome: a role for the inodilator levosimenda
Francesco Fedele, Kristjan Karason, Simon Matskeplishvili
Eur Heart J Suppl. 2017, vol 19(Suppl C): C22–C2
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5932558/
■ Intensification of medication therapy for cardiorenal syndrome in acute descompendade heart failure
Justin L. Grodin, Susanna R. Stevens, Lisa de las Fuentes et al
J Card Fail. 2016 Jan; 22(1): 26–32
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4706474/
■ Epidemiology and natural history of the cardiorenal syndromes in a cohort with echocardiography
Thomas A. Mavrakanas, Aisha Khattak, Karandeep Singh, David M. Charytan
Clin J Am Soc Nephrol. 2017 Oct 6; 12(10): 1624–1633
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5628717/
■ Síndrome Cardiorrenal Tipo 2: Um Forte Fator Prognóstico da Sobrevida
Salim, Arous et al
Int. J. Cardiovasc. Sci., Sept 2017, vol.30, no.5, p.425-43
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2359-56472017000500425&lng=pt&nrm=iso&tlng=pt
■ Cardiorenal syndrome in Western Countries: epidemiology, diagnosis and management approaches
C Ronco, L Di Lullo
Kidney Dis 2016, vol 2: 151-163
https://www.karger.com/Article/FullText/448749
■ Síndrome cardiorrenal tipo 1 en la unidad de cuidados intensivos coronarios del Hospital Nacional Arzobispo Loayza
Preza, Paul M. et al.
Arch. Cardiol. Méx., Set 2015, vol.85, no.3, p.176-187
http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1405-99402015000300002&lng=es&nrm=iso
■ Incidence, mortality and positive predictive value of type 1 cardiorenal syndrome in acute coronary syndrome
Raquel Pimienta González, Patricia Couto Comba, Marcos Rodríguez Esteban et al
PLoS One. 2016; 11(12): e0167166
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5132196/
■ Chronic heart failure and comorbid renal dysfunction – a focus on type 2 cardiorenal syndrome
Jois Preeti, Mebazaa Alexandre, Iyngkaran Pupalan, Thomas C. Merlin, Ronco Claudio
Curr Cardiol Rev. 2016 Aug; 12(3): 186–194
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5011190/
■ Síndrome cardiorrenal: Nuevas perspectivas.
Chávez-López, Ernesto Lenin et al.
Rev. Mex. Cardiol, Mar 2015, vol.26, no.1, p.39-52
http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0188-21982015000100006&lng=es&nrm=iso
■ Prevalence, predictors, and outcomes of cardiorenal syndrome in children with dilated cardiomyopathy: a report from the Pediatric Cardiomyopathy Registry
Ahmad Kaddourah, Stuart L Goldstein, Steven E Lipshultz et al
Pediatr Nephrol. 2015 Dec; 30(12): 2177–218
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4626312/
■ Cardiorenal syndrome and the role of the bone-mineral axxis and anemia
David M. Charytan, Steven Fishbane, Jolanta Malyszko et al
Am J Kidney Dis. 2015 Aug; 66(2): 196–205
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4516683/
■ Advances in the pathogenesis of cardiorenal syndrome type 3
Anna Clementi, Grazia Maria Virzì, Alessandra Brocca et al
Oxid Med Cell Longev. 2015; 2015: 148082
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4364019/
■ Novel renal biomarkers to assess cardiorenal syndrome
Meredith A. Brisco, Jeffrey M. Testani
Curr Heart Fail Rep. 2014 Dec; 11(4): 485–49
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4224613/
■ Pharmacologic management of the cardio-renal syndrome
Chang Seong Kim
Electrolyte Blood Press. 2013 Jun; 11(1): 17–23
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3741438/
■ Advances in the pathogenesis of cardiorenal syndrome type 3
A Clementi, G M Virzi, A Brocca et al
Oxidative Medicine and Cellular Longevity 2015, Article ID 148082, 8 pages
https://www.hindawi.com/journals/omcl/2015/148082/
■ Importance of anemia in the chronic cardiorenal syndrome: effects on renal function after heart transplantation
Alexandre Braga Libório, Russian Soares Uchoa, Alessa Peixoto Aragão et al
Med Sci Monit. 2012; 18(10): CR611–CR616
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3560557/
■ Cardiorenal syndrome type 4 – Cardiovascular disease in patients with chronic kidney disease: epidemiology, pathogenesis, and management
P Pateinakis, A Papagianni
International Journal of Nephrology 2011, Article ID 936-8651, 8 pages
https://www.hindawi.com/journals/ijn/2011/938651/
■ Correction of iron deficiency in the cardiorenal syndrome
D S Silverberg, D Wexler, A Iaina, D Schwartz
International Journal of Nephrology 2011, Article ID 365301, 8 pages
https://www.hindawi.com/journals/ijn/2011/365301/
■ The cardiorenal syndrome: a review
B N Shah, K Greaves
Int J Nephrol 2011; 2011: 920195
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021842/
■ Cardiorenal syndrome: an unsolved clinical problem
P Martínez-Santos, I Vilacosta
International Journal of Nephrology 2011, Article ID 913029, 6 pages
https://www.hindawi.com/journals/ijn/2011/913029/
■ Improving prognosis estimation in patients with heart failure and the cardiorenal syndrome
Husam M. Abdel-Qadir, Shaan Chugh, Douglas S. Lee
Int J Nephrol. 2011; 2011: 351672
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3106377/
■ The cardiorenal syndrome: making the connection
Gautham Viswanathan, Scott Gilbert
Int J Nephrol. 2011; 2011: 283137
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989717/
■ Managing anemia in patients with chronic heart failure: What do we know?
Ankur Sandhu, Sandeep Soman, Michael Hudson, Anatole Besarab
Vasc Health Risk Manag. 2010; 6: 237–252
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2856579/
■ Renocardiac syndromes: physiopathology and treatment stratagems
- G. Kingma, Jr., D. Simard, J. R. Rouleau
Can J Kidney Health Dis. 2015; 2: 41
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4608312/
■ Síndrome cardiorrenal: fisiopatologia e tratamento
Miranda, Samuel de Paula et al.
Rev. Assoc. Med. Bras., 2009, vol.55, no.1, p.89-94
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302009000100022&lng=en&nrm=iso
■ The cardiorenal syndrome
M Jessup, M R Costanzo
Journal of the American College of Cardiology (JACC) 2009, vol 53 (7)
http://www.onlinejacc.org/content/53/7/597
■ Síndrome cardiorrenal, renocárdica, ou …?
E M M Guerra, T M Simabukuro
Rev Fac Ciênc Med Sorocaba 2009, vol 11 (4): 5-9
http://revistas.pucsp.br/RFCMS/article/view/2342/1463
■ Cardiorenal syndrome
C Ronco, M Haapio, A A House et al
Journal of the American College of Cardiology (JACC) 2008, vol 52 (19
http://www.onlinejacc.org/content/52/19/1527
by Dr Paulo Fernando Leite
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