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      Síndrome cardiorrenal: Nuevas perspectivas Translated title: Cardiorenal syndrome: New perspectives

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          Abstract

          La disfunción cardiaca y la renal coexisten con alta prevalencia. Se ha definido a esta entidad clínica como síndrome cardiorrenal y una de sus características principales es la resistencia al tratamiento. Se han descrito múltiples hipótesis para explicar su fisiopatología, como la desregulación hemodinámica y, recientemente, mecanismos neurohumorales e inmunológicos que intervienen en su desarrollo y perpetuación. Se clasifica de acuerdo con su forma de presentación y componentes fisiopatológicos. Existen distintos enfoques terapéuticos para controlar o limitar el progreso de la enfermedad. Esta revisión discute y analiza la información actual sobre la fisiopatología, la clasificación y el tratamiento de esta entidad.

          Translated abstract

          There is a high prevalence of heart failure associated to kidney failure or viceversa. This association has been defined as a clinical entity: cardiorenal syndrome and one of its main characteristics is the resistance to treatment. Multiple hypotheses have been proposed to explain the pathophysiology of this syndrome, such as hemodynamic deregulation and recently, other neurohormonal and immunological mechanisms involved in the development and perpetuation of this pathology. Classifications have been based on the form of presentation or physiopathological manifestations. Different therapeutic approaches have been proposed to control or limit the progress of this disease. This review discusses and analyzes the current information on pathophysiology, different classifications and treatment.

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          Most cited references226

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          K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification.

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            Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention.

            Since the first description of the association between chronic kidney disease and heart disease, many epidemiological studies have confirmed and extended this finding. As chronic kidney disease progresses, kidney-specific risk factors for cardiovascular events and disease come into play. As a result, the risk for cardiovascular disease is notably increased in individuals with chronic kidney disease. When adjusted for traditional cardiovascular risk factors, impaired kidney function and raised concentrations of albumin in urine increase the risk of cardiovascular disease by two to four times. Yet, cardiovascular disease is frequently underdiagnosed and undertreated in patients with chronic kidney disease. This group of patients should, therefore, be acknowledged as having high cardiovascular risk that needs particular medical attention at an individual level. This view should be incorporated in the development of guidelines and when defining research priorities. Here, we discuss the epidemiology and pathophysiological mechanisms of cardiovascular risk in patients with chronic kidney disease, and discuss methods of prevention. Copyright © 2013 Elsevier Ltd. All rights reserved.
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              Importance of venous congestion for worsening of renal function in advanced decompensated heart failure.

              To determine whether venous congestion, rather than impairment of cardiac output, is primarily associated with the development of worsening renal function (WRF) in patients with advanced decompensated heart failure (ADHF). Reduced cardiac output is traditionally believed to be the main determinant of WRF in patients with ADHF. A total of 145 consecutive patients admitted with ADHF treated with intensive medical therapy guided by pulmonary artery catheter were studied. We defined WRF as an increase of serum creatinine >/=0.3 mg/dl during hospitalization. In the study cohort (age 57 +/- 14 years, cardiac index 1.9 +/- 0.6 l/min/m(2), left ventricular ejection fraction 20 +/- 8%, serum creatinine 1.7 +/- 0.9 mg/dl), 58 patients (40%) developed WRF. Patients who developed WRF had a greater central venous pressure (CVP) on admission (18 +/- 7 mm Hg vs. 12 +/- 6 mm Hg, p < 0.001) and after intensive medical therapy (11 +/- 8 mm Hg vs. 8 +/- 5 mm Hg, p = 0.04). The development of WRF occurred less frequently in patients who achieved a CVP <8 mm Hg (p = 0.01). Furthermore, the ability of CVP to stratify risk for development of WRF was apparent across the spectrum of systemic blood pressure, pulmonary capillary wedge pressure, cardiac index, and estimated glomerular filtration rates. Venous congestion is the most important hemodynamic factor driving WRF in decompensated patients with advanced heart failure.
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                Author and article information

                Journal
                rmc
                Revista mexicana de cardiología
                Rev. Mex. Cardiol
                Asociación Nacional de Cardiólogos de México, Sociedad de Cardiología Intervencionista de México (México, DF, Mexico )
                0188-2198
                March 2015
                : 26
                : 1
                : 39-52
                Affiliations
                [03] orgnameSecretaría de Salud orgdiv1Hospital General de México orgdiv2Servicio de Cardiología
                [02] orgnameSecretaría de Salud orgdiv1Hospital General de México
                [01] orgnameSecretaría de Salud orgdiv1Hospital General de México orgdiv2Servicio de Nefrología
                Article
                S0188-21982015000100006 S0188-2198(15)02600100006
                b4cd76d1-d0f2-4446-9d9f-c69f41c692f4

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 157, Pages: 14
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                SciELO Mexico

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                Trabajos de revisión

                insuficiencia renal,Cardiorenal syndrome,heart dysfunction,kidney failure,Síndrome cardiorrenal,insuficiencia cardiaca

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