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Type 2 Cardiorenal Syndrome

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Textbook of Cardiorenal Medicine

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Abstract

The impact of chronic heart disease leading to long term effects in the kidney is known as cardiorenal syndrome type 2 (CRS2). The combination of dysfunction in these two organs is notorious for its significant morbidity. The pathophysiology of CRS2 due to chronic heart failure with reduced ejection fraction (HFrEF) involves hemodynamic factors such as decrease in cardiac output and increase in venous congestion, neurohormonal activation and chronic inflammation while in heart failure with preserved ejection fraction (HFpEF) the hallmark of this condition is an increase in right and left sided heart filling pressures, compromised cardiac filling and consequent inadequate stroke volume reserve. Regardless of the initial trigger, fibrosis appears to be the common aftermath of the chronic inflammatory milieu of cardiorenal syndrome.

The utility of biomarkers in identifying patients at risk for or affected by CRS2 remains unclear. Although estimated glomerular filtration rate and urine albumin to creatinine ratio remain the most widely used markers of kidney impairment with established prognostic impact in cardiovascular disease, contemporary evidence inferred from cohorts of patients treated with neprilysin inhibitors has disputed the concept of albuminuria as a marker of irreversible podocyte injury.

Possible mitigators of CRS2 in HFrEF are neurohormonal blockers such as the inhibitors of the renin-angiotensin system, mineralocorticoid antagonists and the angiotensin receptor-neprilysin inhibitors. For patients with type 2 diabetes who have prominent cardiovascular and renal disease, the sodium-glucose co-transporter 2 inhibitor and the glucagon-like peptide-1 receptor agonist are additional options. Once symptoms become refractory to maximum tolerated medical therapy, devices such as cardiac resynchronization therapy and left ventricular assist devices may be offered. Unlike HFrEF, data on the use of the above mentioned drug classes in HFpEF is scarce and guidelines recommend treatment of congestion and comorbidities.

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Authors and Affiliations

  1. Essential Health Heart and Vascular Center, Duluth, MN, USA

    Natalia Rocha

  2. Baylor University Medical Center, Texas A&M University, Dallas, TX, USA

    Peter A. McCullough

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  1. Natalia Rocha
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  2. Peter A. McCullough
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Correspondence to Natalia Rocha .

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  1. Baylor University Medical Center, Texas A&M University, Dallas, TX, USA

    Peter A. McCullough

  2. Director, Department of Nephrology Dialysis and Transplantation, International Renal Research Institute (IRRIV), Ospedale San Bortolo Vicenza, Vicenza, Italy

    Claudio Ronco

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Rocha, N., McCullough, P.A. (2021). Type 2 Cardiorenal Syndrome. In: McCullough, P.A., Ronco, C. (eds) Textbook of Cardiorenal Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-57460-4_8

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