Seminars in nephrology
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Seminars in nephrology · Jan 2012
ReviewThe role of inflammation in the cardio-renal syndrome: a focus on cytokines and inflammatory mediators.
Cardiovascular and kidney diseases are highly prevalent and frequently are seen in the same patient. This overlap between cardiac and kidney diseases, in part, relates to common etiologies such as diabetes and hypertension. ⋯ In this regard, it is clear that inflammation plays an important role in the pathogenesis of both cardiovascular and renal diseases. Given the circulating nature of many inflammatory mediators (cytokines, immune cells), it is tempting to speculate that the immune system can act as a mediator of organ cross-talk and may be involved in the reciprocal dysfunction that is encountered commonly in cardio-renal syndromes.
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Seminars in nephrology · Jan 2012
ReviewRole of biomarkers in the diagnosis and management of cardio-renal syndromes.
The complex interaction between heart and kidney disease has been increasingly recognized over the recent years. Pathologies within these two organs frequently coexist and, due to organ cross-talk, dysfunction in one often leads to problems in the other. ⋯ To aid in the diagnosis, management and prognosis of these conditions, many novel cardiac and renal biomarkers have emerged to supplement traditional markers which have limited specificity and sensitivity. In this review we will summarize the literature on novel renal behind these and other biomarkers and discuss their potential relevance to the clinical scenarios of cardio-renal syndrome.
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Seminars in nephrology · Jan 2012
ReviewCardio-renal syndrome type 3: epidemiology, pathophysiology, and treatment.
A complex pathophysiology, cardio-renal syndrome (CRS), has been redefined in recent years. One subtype is acute renocardiac CRS, or CRS type 3. This syndrome is intended to comprise situations in which acute kidney injury (AKI) results in acute cardiac injury or dysfunction. ⋯ Results obtained from studies using a standard definition of AKI can lead us to the next step of early recognition, prevention, therapeutic intervention, and improved quality of care. Novel biomarkers and therapeutic interventions for primary and secondary disorders are being developed and tested. The hope is that improved outcomes will follow.
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Seminars in nephrology · Jan 2012
ReviewFluid overload assessment and management in heart failure patients.
Heart failure is a syndrome in which myocardial function is incapable of providing for normal physiologic needs. In the acute care setting, cardiac dysfunction primarily manifests with volume perturbations and presents with signs and symptoms of vascular congestion. Thus, in acute heart failure volume assessment is crucial in diagnosing and improving the prognosis. ⋯ However, these methods are highly dependent on the practitioners' skill level. In fact, there is a high variability between experienced physicians when assessing volume. As adjuncts, objective methods of volume assessment are being developed and used such as natriuretic peptides, bioimpedance analysis, and imaging.