PDF(Pubmed)
Abstract：
Cardiorenal syndrome (CRS), first defined in 2004 as a consequence of the interactions between the kidneys and other circulatory departments leading to acute heart failure, has since been recognized as a complex clinical entity that is hard to define, diagnose and classify. The framework for the classification of CRS according to pathophysiologic background was laid out in 2008, dividing CRS into five distinct phenotypes. However, determining the timing of individual organ injuries and making a diagnosis of either renal or cardiac failure remains an elusive task. In clinical practice, the diagnosis and phenotyping of CRS is mostly based on using laboratory biomarkers in order to directly or indirectly estimate the degree of end-organ functional decline. Therefore, a well-educated clinician should be aware of the effects that the reduction of renal and cardiac function has on the diagnostic and predictive value and properties of the most commonly used biomarkers (e.g. troponins, N-terminal pro-brain natriuretic peptide, serum creatinine etc). They should also be acquainted, on a basic level, with emerging biomarkers that are specific to either the degree of glomerular integrity (cystatin C) or tubular injury (neutrophil gelatinase-associated lipocalin). This narrative review aims to provide a scoping overview of the different roles that biomarkers play in both the diagnosis of CRS and the prognosis of the disease in patients who have been diagnosed with it, along with highlighting the most important pitfalls in their interpretation in the context of impaired renal and/or cardiac function.
摘要：
心肾综合征(CRS),2004年首次定义为肾脏和其他循环系统之间的相互作用导致急性心力衰竭的结果，此后被认为是一个难以定义的复杂临床实体，诊断和分类。根据病理生理背景对CRS进行分类的框架于2008年制定，将CRS分为五种不同的表型。然而,确定单个器官损伤的时机并诊断肾功能衰竭或心力衰竭仍然是一项难以捉摸的任务。在临床实践中,CRS的诊断和表型分析主要基于使用实验室生物标志物,以便直接或间接估计终末器官功能下降的程度.因此,受过良好教育的临床医生应该意识到肾脏和心脏功能的降低对最常用生物标志物的诊断和预测价值和性质的影响(例如肌钙蛋白，N末端脑钠肽前体,血清肌酐等)。他们也应该认识，在基本层面上，针对肾小球完整性（胱抑素C）或肾小管损伤（中性粒细胞明胶酶相关脂质运载蛋白）的新兴生物标志物。这篇叙述性综述旨在概述生物标志物在CRS的诊断和已被诊断患有CRS的患者的疾病预后中所起的不同作用。以及在肾功能和/或心脏功能受损的情况下，强调其解释中最重要的陷阱。
