PDF(Pubmed)
Abstract：
While the existence of cardiorenal perturbations has been known for nearly 2 centuries, only in the past 2 decades has significant progress been made in classifying these alterations and characterizing the pathobiology and hemodynamic signature of cardiorenal syndrome (CRS). Empiric intravenous diuretic therapy with fluid and sodium restriction and selective use of vasoactive agents have remained cornerstones of managing acute heart failure with or without acute CRS; however, recent clinical data has exposed the shortcomings of this approach. The traditional view of CRS has long focused on low cardiac output with resultant renal arterial hypoperfusion as the central hemodynamic derangement but this too, has been challenged by new preclinical and clinical observations. Renal venous congestion/hypertension has since been identified as an important hemodynamic contributor to the development of CRS, resulting in diminished renal perfusion pressure, defined as the difference between arterial driving pressure and renal venous pressure. Novel circulatory renal assist devices for the treatment of acute (type I) CRS are in development and may be divided into 2 broad categories: \"pushers\" which aim to improve renal arterial perfusion (renal preload) and \"pullers\" which are designed to reduce renal venous congestion (renal afterload). Numerous devices have shown promise in early-stage clinical studies but none have been approved yet for commercial use in the United States. The value of CRS device therapies will ultimately rest on safety as well as the ability of these devices to effect predictable, meaningful, and durable improvements in renal function along with clinical and hemodynamic markers of congestion.
摘要：
虽然心肾扰动的存在已经知道了近2个世纪，仅在过去的20年中,在对这些改变进行分类以及表征心肾综合征(CRS)的病理生物学和血流动力学特征方面取得了重大进展.经验性静脉利尿剂治疗与液体和钠限制以及选择性使用血管活性剂仍然是治疗有或没有急性CRS的急性心力衰竭的基石；然而，最近的临床数据暴露了这种方法的缺点。CRS的传统观点长期以来一直集中在低心输出量，导致肾动脉灌注不足，这是中心血流动力学紊乱，但这也是，受到新的临床前和临床观察的挑战。肾静脉充血/高血压已被确定为CRS发展的重要血液动力学因素。导致肾脏灌注压下降，定义为动脉驱动压和肾静脉压之间的差异。用于治疗急性（I型）CRS的新型循环肾脏辅助装置正在开发中，可分为两大类：旨在改善肾动脉灌注（肾前负荷）的“推动器”和旨在减少肾静脉充血（肾后负荷）的“推动器”。许多设备在早期临床研究中显示出希望，但在美国尚未批准商业使用。CRS装置治疗的价值最终将取决于安全性以及这些装置实现可预测效果的能力，有意义的,肾功能的持久改善以及充血的临床和血液动力学标志物。
