Ayşe BİLGİÇ, Hakkı YILMAZ, Nükhet Bavbek RÜZGARESEN, Ali AKÇAY

Kardiyorenal Sendromlar

Kalp ve böbrek hastalıkları çok sık olup, birlikteliği giderek artmaktadır. Kan basıncını, vasküler tonusu, diürez, natriürez, inravasküler hacim dengesini, periferal doku perfüzyonu ve oksijenizasyonunu düzenlemek için kalp ve böbrek işbirliği içinde hareket eder. Kardiyorenal sendrom (KRS) ifadesinin kullanımı giderek artmakla bereber tutarlı veya kabul edilen bir tanımlaması yoktur. Kalp ve böbrekteki hastalıklar nedeniyle bir organdaki akut veya kronik fonksiyon bozukluğunun diğer organda akut veya kronik fonksiyon bozukluğuna yol açmasına kardiyorenal sendrom denir. Kardiyorenal sendromunun patofizyolojisi, sempatik sinir sistemi, renin-anjiyotensinaldosteron sistemi, endotelin ve arginin vazopressin sistemi aktivasyonu da dahil olmak üzere nörohormonal ve hemodinamik mekanizmaları içerir. Kalp ve böbreğin birbirini etkileyen iki yönlü etkileşimi ve zamanlamasını ön planda yansıtan patofizyolojisi esas alınarak kardiyorenal sendromun yeni sınıflamasında 5 alt tipi olduğu öne sürülmüştür. KRS Tip 1= kalp fonksiyonlarının akut bozulması böbrek hasarı ve/veya disfonksiyonuna yol açar; KRS Tip 2=kalp fonksiyonunda kronik bozukluklar böbrek hasarı veya disfonksiyonuna yol açar; KRS Tip 3=akut böbrek fonksiyonlarında bozulma kalp hasarı ve/veya disfonksiyonuna yol açar; KRS Tip 4=kronik böbrek hastalığı kalp hasarı ve/veya disfonksiyonuna yol açar; KRS Tip 5=sistemik durumlar kalp ve böbrekte eşzamanlı hasar ve/veya disfonksiyona yol açar. Kardiyorenal sendromun yönetimi, tıbbi tedavide ilerlemelere ve yeni ajanlar rağmen bir sorun olmaya devam etmektedir. Bu derlemede, kardiyorenal sendromun kanıta dayalı tanımlaması, patofizyolojisi, yeni önerilen sınıflandırması ve çeşitli tedavi yöntemlerini tartıştık.

Anahtar Kelimeler:

Diüretikler, fizyopatoloji, Kardiyorenal sendrom, Yaygınlık

Cardiorenal syndromes

Cardiac and kidney diseases are very common, and increasingly coexist. The heart and kidneys act in tandem to regulate blood pressure, vascular tone, diuresis, natriuresis, intravascular volume homeostasis, peripheral tissue perfusion, and oxygenation. The term cardiorenal syndrome (CRS) increasingly has been used without a consistent or well-accepted definition. The cardiorenal syndrome (CRS) is a disorder of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other. The pathophysiology of the cardiorenal syndrome involves interrelated hemodynamic and neurohormonal mechanisms, including the sympathetic nervous system, the renin-angiotensin-aldosterone system, and endothelin and arginine vasopressin system activation. Recently, a new classification of cardiorenal syndrome has been proposed with five subtypes that reflect the pathophysiology, the bidirectional nature of heart and kidney interaction and the time-frame. CRS type 1= acute worsening of heart function leading to kidney injury and/or dysfunction; CRS type 2 = chronic abnormalities in heart function leading to kidney injury or dysfunction; CRS type 3 = acute worsening of kidney function leading to heart injury and/or dysfunction; CRS type 4 = chronic kidney disease leading to heart injury, disease and/or dysfunction and CRS type 5= systemic conditions leading to simultaneous injury and/or dysfunction of heart and kidney. The management of the cardiorenal syndrome remains a challenge in spite of the advances in medical therapy and novel agents. In this review, we discuss the evidence behind the definition, pathophysiology, new proposed classification and the various therapeutic measures available for cardiorenal syndrome.

Keywords:

Diuretics, physiopathology, Cardio-Renal Syndrome, Prevalence,

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