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Review
. 2021 Oct 26;11(11):1581.
doi: 10.3390/biom11111581.

Cardiorenal Syndrome: New Pathways and Novel Biomarkers

Guido Gembillo  1   2 , Luca Visconti  3 , Maria Ausilia Giusti  4 , Rossella Siligato  1   2 , Alessia Gallo  5 , Domenico Santoro  1 , Alessandro Mattina  4
Affiliations
Review

Cardiorenal Syndrome: New Pathways and Novel Biomarkers

Guido Gembillo et al. Biomolecules. .

Abstract

Cardiorenal syndrome (CRS) is a multi-organ disease characterized by the complex interaction between heart and kidney during acute or chronic injury. The pathogenesis of CRS involves metabolic, hemodynamic, neurohormonal, and inflammatory mechanisms, and atherosclerotic degeneration. In the process of better understanding the bi-directional pathophysiological aspects of CRS, the need to find precise and easy-to-use markers has also evolved. Based on the new pathophysiological standpoints and an overall vision of the CRS, the literature on renal, cardiac, metabolic, oxidative, and vascular circulating biomarkers was evaluated. Though the effectiveness of different extensively applied biomarkers remains controversial, evidence for several indicators, particularly when combined, has increased in recent years. From new aspects of classic biomarkers to microRNAs, this review aimed at a 360-degree analysis of the pathways that balance the kidney and the heart physiologies. In this delicate system, different markers and their combination can shed light on the diagnosis, risk, and prognosis of CRS.

Keywords: KIM-1; NGAL; acute kidney injury; cardiorenal syndrome; chronic renocardiac syndrome; heart; kidney; microRNA; novel biomarkers; proBNP; renal injury.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Different Types of Cardiorenal Syndromes. CRS presents five subtypes characterized by the influence of chronic or acute dysfunction of one organ on another. The acute dialysis quality initiative classification of CRS is helpful to drive the clinicians to the best therapeutic strategies depending on the primum movens of the syndrome. The complex interconnection of this condition is characterized by oxidative stress and inflammation-driven damage.
Figure 2
Figure 2
Bidirectional mechanisms in cardiorenal axis pathophysiology. CRS presents a common pathogenesis characterized by hemodynamic, neurohormonal, inflammatory mechanisms also involving the atherosclerotic degeneration. RAAS system plays a major role in CRS pathophysiology, tipping the scale in the delicate balance between heart and kidney. Abbreviations: CI: cardiac index, CO: cardiac output, GFR: glomerular filtration rate, RAAS: renin–angiotensin–aldosterone system.
See this image and copyright information in PMC

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