心肾综合征是指心脏或肾脏的相互关联的功能障碍,导致一系列反馈机制,血液动力学,神经激素,和免疫和/或生化反馈途径引起另一个器官的损害。心肾综合征根据器官损伤的原发诱因分为五种临床亚型,并与高发病率和死亡率相关。因此,在住院患者中最早识别心肾综合征的工具的开发对于改善这些患者的预后和结局具有非常重要的意义。人们对识别作为生物标志物的分子越来越感兴趣,反映血液动力学变化,心脏和肾脏损伤和/或功能障碍以及氧化应激诱导的细胞损伤或心脏和肾脏细胞外基质的变化。生物标志物为心肾综合征的病理生理学提供了重要的见解,并且是预测心功能不全期间肾功能下降的宝贵工具,反之亦然。基于心肾综合征的病理生理机制,我们回顾并评估了有关血清和尿液生物标志物作为肾脏和/或心脏损伤预测因子的现有文献.此外,心脏和肾脏特异性生物标志物也分别根据它们对肾脏和心脏功能的参考进行评估。以及它们是否会提供心肾综合征的任何预测和预后。在这篇文章中,我们讨论了当前关于不同类型心肾综合征的病理生理学的知识,检查候选生物标志物在心肾综合征早期诊断中的临床效用,并通过评估所涉及的病理生理途径的各自作用来指导治疗。
Cardiorenal syndrome refers to the interrelated dysfunction of the heart or kidney resulting in a cascade of feedback mechanisms, hemodynamic, neurohormonal, and immunological and/or biochemical feedback pathways causing damage in the other organ. Cardiorenal syndrome is categorized into five clinical subtypes depending on the perceived primary precipitant of organ injury and is associated with high morbidity and mortality. Therefore, the development of tools for the earliest identification of cardiorenal syndrome in hospitalized patients is of extremely high significance to ameliorate the prognosis and outcome of these patients. There is increasing interest in identifying molecules serving as biomarkers, reflecting hemodynamic changes, heart and kidney damage and/or dysfunction and oxidative stress-induced cell damage or changes in the extracellular matrix of both the heart and kidneys. Biomarkers provide important insights into the pathophysiology of cardiorenal syndrome and are invaluable tools to predict the decrease in renal function during cardiac dysfunction and vice versa. Based on the pathophysiological mechanisms of cardiorenal syndrome, we reviewed and evaluated the available literature on serum and urinary biomarkers as predictors of kidney and/or heart injury. In addition, heart- and kidney-specific biomarkers were also evaluated based on their reference to kidney and cardiac (dys)function respectively, and whether they would provide any prediction and prognostication of cardiorenal syndrome. In this article, we discuss the current knowledge on the pathophysiology of different types of cardiorenal syndrome, examine the clinical utility of candidate biomarkers in the early diagnosis of cardiorenal syndrome, and guide treatment by evaluating the respective roles of the involved pathophysiological pathways.