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Range of adiposity and cardiorenal syndrome

World Journal of Diabetes 2020年第8期11卷 322-350页

作者： Fernando Pazos Department of Medicine Medicine FacultyCantabria UniversityValdecilla HospitalSantander 39080CantabriaSpain

Obesity and obesity-related co-morbidities,diabetes mellitus,and hypertension are among the fastest-growing risk factors of heart failure and kidney disease ***,which is not a unitary concept,or a static process,ranges from alterations in distribution to the amount of *** adiposity,which includes intraabdominal visceral fat mass and ectopic fat deposition such as hepatic,cardiac,or renal,was robustly associated with a greater risk for cardiorenal morbidity than subcutaneous *** addition,morbid obesity has also demonstrated a negative effect on cardiac and renal *** mechanisms by which adipose tissue is linked with the cardiorenal syndrome(CRS)are hemodynamic and mechanical changes,as well neurohumoral pathways such as insulin resistance,endothelial dysfunction,nitric oxide bioavailability,renin-angiotensin-aldosterone,oxidative stress,sympathetic nervous systems,natriuretic peptides,adipokines and *** and other associated co-morbidities induce adverse cardiac remodeling and interstitial *** failure with preserved ejection fraction has been associated with obesity-related functional and structural *** might also impair kidney function through hyperfiltration,increased glomerular capillary wall tension,and podocyte dysfunction,which leads to tubulointerstitial fibrosis and loss of nephrons and,finally,chronic kidney *** development of new treatments with renal and cardiac effects in the context of type 2 diabetes,which improves mortality outcome,has highlighted the importance of CRS and its *** body fat triggers cellular,neurohumoral and metabolic pathways,which create a phenotype of the CRS with specific cellular and biochemical *** has become a single cardiorenal umbrella or type of cardiorenal metabolic *** review article provides a clinical overview of the available data on the relationship between a range of adiposity

关键词： Obesity Morbid obesity cardiorenal syndrome Heart failure Chronic kidney disease

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cardiorenal syndrome： pathophysiological mechanism, preclinical models, novel contributors and potential therapies

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Chinese Medical Journal 2014年第16期127卷 3011-3018页

作者： Fu Qiang Cao Longxing Li Huang Wang Binghui Li Zhiliang Cardiovascular Division Zhujiang Hospital Southern Medical University Guangzhou Guangdong 510280 China Centre of Cardiovascular Research and Education in Therapeutics Department of Epidemiology and Preventive Medicine School ofPublic Health and Preventive Medicine Faculty of Medicine Nursingand Health Sciences Monash University Melbourne Australia

Objective To review the current knowledge about the pathophysiological mechanisms,preclinical models,novel contributors and potential therapies of cardiorenal *** sources The literature concerning cardioranal syndrome in this review was collected from PubMed published in English up to January *** selection Original articles and critical reviews related to cardiorenal syndrome were selected and carefully *** cardiorenal syndrome is a condition characterized by kidney and heart failure where failure of one organ worsens the function of the other thus further accelerating the progressive failure of both *** pathophysiology of cardiorenal syndrome is not fully understood,but may be caused by a complex combination of neurohormonal system activation,endothelial dysfunction,proteinuria,oxidative stress,uremic toxins and other *** cardiorenal syndrome is still a major therapeutic challenge in clinical practice because many of the drugs used to control heart failure can worsen renal function,and vice ***-dialyzable uremic toxins,such as indoxyl sulfate,causing detrimental effects on the heart and kidney as well as stimulation of inflammatory responses,may be an effective therapeutic target for cardiorenal *** Suitable disease models of cardiorenal syndrome are urgently needed to investigate the pathophysiology and effective therapeutic approaches to the ***-dialyzable protein-bound uremic toxins that may have cardiac and renal effects may provide therapeutic benefit to cardiorenal syndrome patients.

关键词： cardiorenal syndrome pathophysiology preclinical models uremic toxins

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Impact of erythropoietin therapy on cardiorenal syndrome:A systematic review with meta-analysis

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World Journal of Cardiology 2023年第5期15卷 273-283页

作者： Rubal Bhangal Ivan Cancarevic Mahmoud Nassar Zaryab Umar Department of Internal Medicine Icahn School of Medicine at Mount Sinai/NYC Health+Hospitals QueensNew YorkNY 11432United States Department of Internal Medicine Icahn School of Medicine at Mount SinaiNew YorkNY 10029United States Department of Internal Medicine NYC Health+Hospital QueensNew YorkNY 11432United States

BACKGROUND Heart and kidney dysfunction frequently coexist in patients with acute heart failure due to the overlap between these two organ *** syndrome(CRS)results from pathology occurring in the heart and kidneys along with the consequences of dysfunction in one organ contributing to dysfunction in the other and vice *** To evaluate the use of erythropoietin(EPO)in patients with CRS and its effects on hemoglobin(Hb),major cardiovascular(CV)events,and hospitalization *** On February 24,2022,searches were conducted using PubMed,MEDLINE,and EMBASE,and 148 articles were identified.A total of nine studies were considered in this systematic *** assessed the included articles based on the National Heart,Lung,and Blood Institute quality assessment tools for controlled intervention and observational cohort or cross-sectional *** assessment of bias risk was conducted on the chosen studies,and data relevant to our review was *** The systematic review of these studies concluded that most existing literature indicates that EPO improves baseline Hb levels and decreases myocardial remodeling and left ventricular dysfunction without reducing CV *** addition,the effect of EPO on the hospitalization rate of patients with CRS needs to be further studied since this relationship is *** studies,such as randomized controlled clinical trials and prospective cohort studies,should be conducted to enhance the literature on the potential of EPO therapy in patients with *** Our systematic review suggests that EPO therapy may have a significant role in managing *** review highlights the potential benefits of EPO in improving baseline Hb levels,reducing the risk of major CV events,improving cardiac remodeling,myocardial function,New York Heart Association class,and B-type natriuretic peptide ***,the effect of EPO treatment on hospitalization remains unclear and needs further exploration.

关键词： cardiorenal syndrome Anemia Cardiovascular disease End-stage renal disease Erythropoietin Congestive heart failure

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Rosuvastatin alleviates renal injury in cardiorenal syndrome model rats through anti-inflammatory and antioxidant pathways

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Emergency and Critical Care Medicine 2022年第4期2卷 203-208页

作者： Biye Zhou Qiangguo Ao Hua Zhao Ping Ye a Department of Emergency Medicine The Sixth Medical CenterChinese PLA General HospitalBeijingChina Department of Nephrology The Second Medical Center&National Clinical Research Center for Geriatric DiseasesChinese PLA General HospitalBeijingChina Central Medical District of Chinese PLA General Hospital BeijingChina Department of Cardiology The Second Medical CenterChinese PLA General HospitalBeijingChina.

Background:cardiorenal syndrome is increasingly common and has been reported to be associated with inflammation and oxidative stress,and statins have anti-inflammatory and antioxidant ***,we designed this experiment to study the preventive effect of statins on cardiorenal *** aim of the study is to investigate the effect of early rosuvastatin use on cardiorenal ***:Forty-five Wistar rats were randomly divided into 3 groups.A unilateral nephrectomy group(Group 1),a unilateral nephrectomy+coronary ligation group(Group 2),and a unilateral nephrectomy+coronary ligation+rosuvastatin group(Group 3).Right kidney removal was performed on all rats during the first week,while Group 3 was given statin intragastric administration at 10 mg/kg/*** month later,coronary ligation was performed on rats in Groups 2 and *** 3 continued statin *** feeding for 3 months and 2 days,the rats were killed;urine and blood were collected and sent to the laboratory for the determination of the urinary protein/creatinine ratio and blood lipid,creatinine,and urea nitrogen levels,*** interleukin 1β,interleukin 6,malondialdehyde,glutathione peroxidase,angiotensin II,neutrophil gelatinase-associated lipocalin,cystatin C,and B natriuretic peptide levels were also deter*** the day before euthanasia,all rats were anesthetized and examined by cardiac ***-eosin and periodic acid–Schiff staining were performed on heart and kidney ***:The ejection fraction in Group 2 was lower than that in Group 1(P<0.01).The ejection fraction value in Group 3 was lower than that in Group 1(P<0.01).Interleukin-1βlevels in Group 2 were higher than those in Group 1(P<0.01).Interleukin-1βlevels in Group 3 were lower than those in Group 2(P<0.01).The malondialdehyde value in Group 3 was lower than that in Group 2(P<0.05).Histopathology showed that Group 1 had slight renal damage,renal injury was aggravated in Group 2,a

关键词： cardiorenal syndrome Heart failure Rosuvastatin

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Renal Profile of Patients with cardiorenal syndrome: Nephrology and Cardiology Department Experience of the University Hospital IBN SINA of Rabat

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Open Journal of Nephrology 2023年第3期13卷 263-279页

作者： Mariam El Galiou Hajar Fitah Naima Ouzeddoun Rabia Bayahya Tarik Bouattar Laila Lahlou Nawal Doghmi Loubna Benamar Nephrology-Dialysis-Renal Transplantation Department CHU Ibn Sina Mohamed V University Rabat Morocco Laboratory of Biostatistics Clinical Research and Epidemiology Department of Public Health Mohamed V University Rabat Morocco Department of Cardiology B Ibn Sina University Hospital Mohamed V University Rabat Morocco

Introduction: Cardio-renal syndrome (CRS) is a complex pathophysiological entity affecting the heart and kidneys in which acute or chronic dysfunction of one organ can induce acute or chronic dysfunction of the other organ. Five types of CRS have been described. Methods: The study explored the prevalence and types of cardiorenal syndrome (CRS) at CHU Ibn Sina in Rabat. Over a year, 120 CRS patients were assessed, excluding those with end-stage chronic renal failure. We analyzed the epidemiological, clinical, therapeutic and evolutionary profile of these patients. Results: The average age of our patients is 67.8 ± 12 years, with extremes ranging from 39 years to 92 years. The sex ratio is 1.35. The different types of CRS types (1, 2, 4 and 5) were noted respectively in 28.4%, 20.8%, 5%, 45.8%, however, we did not note patients having CRS type 3. On the renal level, we noted acute renal failure (ARF) in 51.6% of patients, of whom 61.3% had functional ARF and 38.7% presented with acute tubular necrosis. Chronic renal failure (CRF) is found in 48.4% of cases, of which 39% are at stage III and 61% are at stage IV. The etiology of CKD is dominated by hypertensive nephropathy (72.4%) followed by diabetic nephropathy (60.3%). Therapeutically diuretics are administered in 51% of our patients. We used hemodialysis in 9.1% of patients who are resistant to diuretics. Vasoactive drugs are used in 9.5% of our patients. Mortality risk factors for patients with CRS are significantly related to advanced age, long hospital stay, type 1 CRS, re-hospitalization, acute pulmonary edema (APE), use of hemodialysis, right heart failure (RHF), valvulopathy and hemodynamic instability (OR = 1.15, p = 0.01;OR = 4.5, p = 0.03;OR = 5.2, p = 0.019;p Conclusion: CRS type 5 was most common, with hypertension and diabetes being primary causes of Chronic Kidney Disease. Mortality factors were linked to acute pulmonary edema, hemodialysis, right heart failure, valvulopathy, and re-hospitalization.

关键词： cardiorenal syndrome Acute Kidney Injury Diabetes Sepsis Hemodialysis

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Evidence based review of management of cardiorenal syndrome type 1

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World Journal of Methodology 2021年第4期11卷 187-198页

作者： Leong Tung Ong Faculty of Medicine University of MalayaKuala Lumpur 50603Wilayah Persekutuan Kuala LumpurMalaysia

cardiorenal syndrome(CRS)type 1 is the development of acute kidney injury in patients with acute decompensated heart *** often results in prolonged hospitalization,a higher rate of rehospitalization,high morbidity,and high *** pathophysiology of CRS is complex and involves hemodynamic changes,neurohormonal activation,hypothalamic-pituitary stress reaction,inflammation,and ***,there is limited evidence or guideline in managing CRS type 1,and the established therapeutic strategies mainly target the symptomatic relief of heart *** review will discuss the strategies in the management of CRS type *** clinical studies have been included in this review that include different treatment strategies such as nesiritide,dopamine,levosimendan,tolvaptan,dobutamine,and *** strategies for CRS type 1 are derived based on the current *** recognition and treatment of CRS can improve the outcomes of the patients significantly.

关键词： cardiorenal syndrome Heart failure Acute kidney injury Renal insufficiency Management

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Gingerol improves cardiac function in rats with cardiorenal syndrome via inhibiting fibrosis

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South China Journal of Cardiology 2021年第2期22卷 135-144,F0003页

作者： DENG Ting WU Ying-zhi Akindavyi Gael LIU Yun-feng LI Zhi-liang FU Qiang DENG Xiao-fang Department of Cardiovascular Disease First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhou510006China Department of Cardiology Zhujiang HospitalSouthern Medical UniversityGuangzhou510280China Department of Cardiology South China hospital of Shenzhen UniversityShenzhen518110China Department of Cardiology Shenzhen HospitalSouthern Medical UniversityShenzhen518110China Department of neonatology Guangdong Provincial People's HospitalGuangzhou510080China

Background cardiorenal syndrome(CRS)is a clinical syndrome with a complex mechanism,and there is currently no specific *** was confirmed to possess anti-inflammatory,antioxidant and cardiotonic properties as cardiovascular pharmacological ***,in vivo studies have yet to prove that it can improve cardiac function and inhibit fibrosis in rats with cardiorenal *** In this study,34 male Sprague-Dawley(SD)rats were randomly divided into control(n=9),model(n=12)and gingerol groups(n=13).The model and the gingerol groups underwent ligation of the left anterior descending coronary artery and 5/6 subtotal nephrectomy to construct a type 2 cardiorenal syndrome rat *** rats in gingerol group were injected intraperitoneally with 50 mg/kg *** same amount of saline was administered to both the control and the model *** 4 weeks of treatment,the rat cardiac function and myocardial fibrosis were evaluated by cardiac ultrasound and blood *** Biochemical results showed that the brain natriuretic peptide(BNP)levels of gingerol group decreased(P<0.05).Cardiac ultrasound revealed that gingerol improved cardiac systolic function and ventricular remodeling(P<0.05).The systolic function of the model group was significantly decreased compared with the control *** staining confirmed that the fibrosis area in the model group was significantly augmented than that in the control group,while the area of fibrosis in the gingerol group was diminished compared to the model group(P<0.01).Moreover,immunofluorescence showed that compared with the control group,the expression of collagen 1,TGF-β1 andα-SMA was significantly increased in the model group,and both collagen deposition and the expression of collagen I,TGF-β1 andα-SMA decreased in gingerol *** revealed that the expression of collagen 1 andα-SMA was significantly increased in the model group compared with the control group,while

关键词： gingerol cardiorenal syndrome fibrosis heart function

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Fluid overload as a major target in management of cardiorenal syndrome:Implications for the practice of peritoneal dialysis

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World Journal of Nephrology 2017年第4期6卷 168-175页

作者： Amir Kazory Division of Nephrology Hypertension and Renal TransplantationCollege of MedicineUniversity of Florida

Congestion is an integral component of cardiorenal syn-drome and portends an adverse impact on the outcomes. Recent studies suggest that congestion has the ability ofmodulating the interactions between the kidney and the heart in this setting. Peritoneal dialysis （PD） is a home-based therapeutic modality that is not only offered to patients with end-stage renal disease to provide solute clearance and ultrafltration, but it has also been used in patients with refractory heart failure and fuid overload to help optimize volume status. Several uncontrolled studies and case series have so far evaluated the role of PD in management of hypervolemia for patients with heart failure. They have generally reported favorable results in this setting. However, the data on the outcomes of patients with end-stage renal disease and concomitant heart failure is mixed, and the proposed theoretical advantages of PD might not translate into improvedclinical endpoints. Congestion is prevalent in this patient population and has a signifcant effect on their survival. As studies suggest that a significant subset of patients with end-stage renal disease who receive PD therapy are hypervolemic, suboptimal management of congestion could at least in part explain these conficting results. PD is a highly fexible therapeutic modality and the choice oftechniques, regimens, and solutions can affect its ability for optimization of fluid status. This article provides an overview of the currently available data on the role and clinical relevance of congestion in patients with cardiorenal syndrome and reviews potential options to enhance decongestion in these patients.

关键词： Heart failure Peritoneal dialysis Congestion cardiorenal syndrome

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Hepatocardiorenal syndrome in liver cirrhosis:Recognition of a new entity?

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World Journal of Gastroenterology 2024年第2期30卷 128-136页

作者： Henry H L Wu Amina Rakisheva Arvind Ponnusamy Rajkumar Chinnadurai Renal Research Kolling Institute of Medical ResearchRoyal North Shore Hospital&The University of SydneySt.Leonards(Sydney)2065New South WalesAustralia Department of Cardiology City Cardiological CenterAlmaty 050000Kazakhstan Department of Renal Medicine Royal Preston HospitalPreston PR29HTUnited Kingdom Donal O’Donoghue Renal Research Centre&Department of Renal Medicine Northern Care Alliance National Health Service Foundation TrustSalford M68HDUnited Kingdom

Emerging evidence and perspectives have pointed towards the heart playing an important role in hepatorenal syndrome(HRS),outside of conventional understanding that liver cirrhosis is traditionally considered the sole origin of a cascade of pathophysiological mechanisms directly affecting the kidneys in this *** the absence of established heart disease,cirrhotic cardiomyopathy may occur more frequently in those with liver cirrhosis and kidney *** is a specific form of cardiac dysfunction characterized by blunted contractile responsiveness to stress stimuli and altered diastolic relaxation with electrophysiological *** the clinical description of these potential cardiac-related complications of the liver,the role of the heart has traditionally been an overlooked aspect of circulatory dysfunction in *** from a physiological sense,temporality(prior onset)of cardiorenal interactions in HRS and positive effects stemming from portosystemic shunting demonstrated an important role of the heart in the development and progression of kidney dysfunction in cirrhotic *** this review,we discuss current concepts surrounding how the heart may influence the development and progression of HRS,and the role of systemic inflammation and endothelial dysfunction causing circulatory dysfunction within this *** temporality of heart and kidney dysfunction in HRS will be *** a subgroup of patients who receive portosystemic shunting,the dynamics of cardiorenal interactions following treatment is *** research to determine the unknowns in this topic is anticipated,hopefully to further clarify the intricacies surrounding the liver-heart-kidney connection and improve strategies for management.

关键词： Hepatorenal syndrome cardiorenal syndrome Cirrhosis Cardiac dysfunction Circulatory dysfunction

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Role of imaging in the evaluation of renal dysfunction in heart failure patients

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World Journal of Nephrology 2017年第3期6卷 123-131页

作者： Dario Grande Paola Terlizzese Massimo Iacoviello School of Cardiology Univer- sity of Bari Cardiology Unit Cardiothoracic DepartmentPoliclinic University Hospital

Heart failure and kidney disease share common pathophysiological pathways which can lead to mutual dysfunction,known as cardiorenal *** heart failure patients,renal impairment is related to hemodynamic and nonhemodynamic *** decreased renal blood flow and renal venous congestion due to heart failure could lead to impaired renal *** disease and worsening renal function are independently associated with poor prognosis in heart failure patients,both in acute and chronic clinical *** aim of this review is to assess the role of renal imaging modalities in the evaluation and management of heart failure *** imaging techniques could complete laboratory data,as estimated glomerular filtration rate,exploring different pathophysiological factors involved in kidney disease and adding valuable information about renal structure and *** particular,Doppler examination of arterial and venous hemodynamics is a feasible and non invasive technique,which has proven to be a reliable method for prognostic stratification in patients with cardiorenal *** renal resistance index,a measure related to renal hemodynamics,can be calculated from the Doppler evaluation of arterial ***,the analysis of Doppler venous flow patterns can integrate information from the arterial study and evaluate renal *** imaging modalities are promising,but still confined to research purposes.

关键词： Heart failure Doppler Renal resistance index Hemodynamics Venous Doppler Prognosis cardiorenal syndrome Chronic kidney disease

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