Cardiorenal Syndrome Type 3 Review

Abstract

The management of patients with complex comorbidity involving several organ systems can use an approach focused on each organ system independently or can use an approach trying to integrate various injuries and dysfunction into a single syndrome. Cardiorenal syndromes can develop with an initial injury to either the heart or kidney and then sequential involvement of the second organ. This can occur acutely or chronically. Cardiorenal syndrome type 3 is defined by acute renal injury with subsequent cardiac injury and/or dysfunction. Studies on these patients must use strict inclusion criteria. Pavan reported information on 100 patients with acute kidney injury in India to determine the frequency of cardiorenal syndrome type 3. He excluded patients with significant prior comorbidity. The most frequent causes of acute kidney injury in these patients were drug toxicity, gastroenteritis with volume contraction, and obstetrical complications. This study included 100 patients with acute kidney injury, and 29 developed cardiorenal syndrome type 3. Important outcomes included frequent mortality and chronic renal failure. Other studies have reported that cardiorenal syndrome type 3 occurs relatively infrequently. The analysis of large data bases has demonstrated that the development of acute kidney injury in hospitalized patients has important consequences, including the development of heart failure and increased mortality, but the complexity of these cohorts makes it difficult to determine the time course for the development of multisystem disorders. The pathogenesis of cardiorenal syndrome type 3 involves mitochondrial dysfunction, immune dysregulation, and ischemia-reperfusion. Cardiac events occur secondary to fluid overload, electrolyte disorders, and uremic toxins. These patients need increased attention during hospitalization and outpatient management in an effort to slow the progression of the primary disorder and treat complications.

Does cardiac impairment develop in ischemic renal surgery in rats depending on the reperfusion time?

“…In fact, inefficient post-renal repair can lead to long-lasting morbidity and even mortality due to renal and non-renal causes [ 33 ]. Many studies have shown that patients after kidney transplantation surgery develop ischemic heart disease, congestive heart failure and left ventricular hypertrophy [ 6 , 15 ]. In the present study, we explored the connectivity between renal IR surgery repair and recovery with cardiac function.…”

“…The mechanisms underlying the distant cardiac effects of renal IRI remain to be fully elucidated, but they are likely to involve a complex interplay of systemic inflammation, neurohormonal activation, mitochondrial dysfunction, oxidative stress, and endothelial dysfunction [ [14] , [15] , [16] ] [ [14] , [15] , [16] ] [ [14] , [15] , [16] ]. Among these pathological mediators, mitochondrial dysfunction is generally overlooked despite its potential to be involved in the crosstalk between the pathologies and coordinate them all due to the difficulty in mitochondrial health assessment as compared to other mentioned parameters [ 17 , 18 ].…”

Acute Renal Infarction After a Bilateral Aortic-Iliac Stent Thrombosis

“…We present a case of progressive renal infarction caused by chronic thrombosis of bilateral aortic-iliac stenting in place for more than 10 years. A complex clinical picture, complicated by type 3 cardio-renal syndrome [ 5 ], caused a delay in diagnosis. At the time of the definitive diagnosis, there was no longer indication for reperfusion therapy, and the patient needed transitory renal function replacement therapy [ 2 ].…”

Dual-specificity phosphatase 1 interacts with prohibitin 2 to improve mitochondrial quality control against type-3 cardiorenal syndrome

“…Various pathophysiological processes contribute to the occurrence and development of CRS-3. Fluid retention during acute kidney injury can lead to pulmonary edema 5 . Electrolyte disturbances such as hyperkalemia can cause arrhythmias and even cardiac arrest 6 .…”