Acute kidney injury in cardiorenal syndrome

Abstract

The incidence of acute kidney injury (AKI) as a result of acute cardiac failure is an increasingly frequent phenomenon driven by demographic change and medical progress. The main underlying pathophysiologic mechanism of this so-called cardiorenal syndrome type 1 (CRS1) is venous congestion in conjunction with neurohumoral activation and inflammation. The prevention, diagnosis and treatment of CRS1 focus on treating the cardiac condition including decongestive recompensation. This article provides nephrologists with the current definitions and differential diagnoses of acute heart failure. In addition, the epidemiology and pathophysiology of AKI in the course of cardiac insufficiency are described. A stepwise approach for treatment and monitoring is provided according to the current consensus and the evidence. This includes mechanisms and principles of the use of diuretics. Finally, pertinent interventional studies on the pharmacotherapy of congestive heart failure are summarized.