Cardiorenal syndrome is a disease that affects the heart and kidneys at the same time. The syndrome is also often referred to by the abbreviation KRS. A chronic or acute impairment of the function of one organ leads to an impairment of the other. The name originally comes from the treatment of cardiac insufficiency. The cardiac insufficiency was limited by the impairment of the kidney function.
What is Cardiorenal Syndrome?
Diagnosis of cardio-renal syndrome is based on established diagnostic criteria related to kidney and heart disease.
In cardio-renal syndrome, the heart and kidneys interfere with each other’s functions. The interactions between the two organs are different depending on the individual case. However, the disease can be divided into different types. See AbbreviationFinder for abbreviations related to KRS.
The term cardiorenal syndrome is used to differentiate individual manifestations when a disease of the heart leads to an impairment of the function of the kidneys. The term renocardial syndrome is used when a disease of the kidney affects the heart. In addition, the term also includes the condition in which an underlying disease causes simultaneous damage to the heart and kidneys.
Reliable data on the frequency of cardio-renal syndrome are scarce. Chronic kidney failure affects 20 to 60 percent of people with stable heart failure. If the cardiac insufficiency decompensates acutely, a simultaneous renal insufficiency occurs with an increased probability of almost 70 percent. If end-stage renal failure is present, heart failure is the most common cause of death.
In the development of the cardiorenal syndrome, the heart and kidneys influence each other. Heart failure impairs the functioning of the kidneys, while renal failure impairs the functioning of the heart. Cardiorenal syndrome is divided into four types.
Types 1 and 2 include cardio-renal influences. Heart failure leads to a deterioration in kidney function. The reasons for this have not yet been fully explored. Originally, the explanation was that the kidneys are less well supplied with blood because the heart’s pumping function is reduced. The resulting kidney failure is also referred to as prerenal.
However, various studies have not been able to show any connection between the severity of kidney weakness and the cardiac pump function. Instead, it is primarily those patients who suffer from kidney failure in whom increased pressure has been measured in the veins that flow into the heart.
Therefore, physicians now assume that the accumulation of blood in front of the heart plays a greater role. In types 3 and 4, renocardial influences are in the foreground. Kidney failure puts an increased strain on the heart because the heart has to transport a larger volume of blood. This gradually develops heart failure.
Symptoms, Ailments & Signs
Depending on the type and stage, the cardio-renal syndrome manifests itself through various symptoms.
- Type 1 is characterized by acute heart failure associated with acute renal failure. In addition, cardiac arrhythmias, myocarditis and cardiogenic shock often occur .
- Type 2 is characterized by chronic heart and kidney failure. Defects in the heart valves and a so-called cardiomyopathy are also possible. at
- Type 3 is acute kidney failure in combination with acute heart disease. In some cases, cardiac arrhythmia, acute coronary syndrome or pulmonary edema also occur. Kidney failure can be caused by contrast media. Interstitial nephritis and urinary retention can also develop.
- Type 4 is characterized by chronic kidney and heart failure. Glomerulonephritis and cystic kidneys are also possible.
- In type 5, there is either acute or chronic heart failure associated with acute coronary syndrome and acute renal failure. Even sepsis and diabetes mellitus as well as amyloidosis are possible with this type. It should be noted that a clinically precise classification is often impossible. Chronic heart failure and chronic kidney failure often occur together because they are largely due to the same risk factors.
Diagnosis & course of disease
Diagnosis of cardio-renal syndrome is based on established diagnostic criteria related to kidney and heart disease. An existing cardiac insufficiency is diagnosed using the criteria of the so-called European Heart Association. Acute renal failure is usually subdivided and diagnosed using the RIFLE criteria, while chronic renal failure uses the KDIGO or KDOQI criteria.
Basically, when diagnosing the cardio-renal syndrome, the focus is on discussing the patient’s medical history, which gives the attending specialist information on further diagnostic and therapeutic procedures.
In most cases, this syndrome causes various symptoms. Those affected usually suffer from kidney and heart problems. The quality of life is greatly reduced and the resilience of the person affected drops just as enormously. In the worst case, this can lead to complete renal insufficiency, so that the patient is dependent on a donor kidney or on dialysis.
Patients also suffer from cardiac arrhythmia and, in the worst case, can suffer cardiac death. Life expectancy is reduced by this syndrome if untreated. There can also be problems with the lungs, so that the patients also suffer from shortness of breath or gasping. It is not uncommon for diabetes to occur.
Furthermore, the various complaints can also lead to psychological complications or depression. These can be treated by a psychologist. It is not possible to treat this syndrome causally. For this reason, treatment is exclusively symptomatic. Life expectancy may be limited. In acute emergencies, an organ transplant may be necessary.
When should you go to the doctor?
If the typical symptoms of cardio-renal syndrome are noticed, a doctor should be consulted. People should seek medical advice if they feel unwell for several days or weeks. Symptoms such as urinary retention or breathing difficulties indicate a serious illness that requires clarification by a doctor. At the latest when kidney problems occur, medical advice must be sought. The affected person should see their family doctor or a nephrologist.
Early diagnosis improves the chances of a speedy recovery. If left untreated, cardio-renal syndrome progresses and causes symptoms such as kidney failure or sepsis. At this stage, emergency medical care is required. The person concerned must be taken to a practice or hospital immediately, as there is an acute danger to life. After the initial treatment, the patient must consult other doctors in order to rule out or treat any secondary diseases. People who suffer from cardiac insufficiency or renal insufficiency are particularly susceptible to the development of cardio-arenal syndrome and should consult a doctor immediately if the warning signs mentioned above appear.
Treatment & Therapy
Cardiorenal syndrome is treated depending on the type and symptoms shown. It is always central to treat the underlying diseases and to minimize possible risk factors. In the hospital, those affected are treated primarily for acute fluid overload (hydropic decompensation).
Edema in the limbs, shortness of breath caused by pulmonary edema or pleural effusions indicate fluid overload. In order to support kidney function, fluid balance must be regulated. In case of excess, the amount of drinking should be limited. So-called diuretic or water-inducing agents can also reduce fluid overload.
Outlook & Forecast
In addition to a detailed medical diagnosis and the resulting treatment plan, the person concerned can also become active themselves. The extent to which this is possible depends largely on the cause of the disease and the medical treatment chosen.
Avoiding physical activity combined with bed rest helps relieve symptoms regardless of the cause. A change in diet coordinated with the doctor and avoiding addictive substances can reduce the dose of medication and relieve the cardiovascular system.
In order to improve kidney function, it is necessary to optimize fluid balance. If there is excess fluid, the fluid intake must be reduced in consultation with the doctor. Foods such as asparagus or carrot juice support this effect, as do any prescribed diuretics. If this does not bring about the desired success, a temporary dialysis therapy can also be discussed with the doctor. This stabilizes the condition of the renal insufficiency until the drug treatment of the cardiac insufficiency is successful.
If, on the other hand, there is a lack of fluids, increased fluid intake in the form of water, herbal and fruit teas or fruit spritzers will have a supportive effect. Of course, diuretic foods should be avoided here.
Since both excessive fluid withdrawal and excessive fluid intake lead to a significant worsening of the symptoms, regular monitoring of kidney function and electrolyte balance is essential and self-therapy is adjusted accordingly to these values.
Preventive measures for the cardio-renal syndrome are closely related to the prevention of cardiac and renal insufficiency. Lifestyle risk factors should be minimized. Regular check-ups at the doctor’s give early indications of a deterioration in the organ functions of the heart and kidneys.
In most cases, follow-up care options for this syndrome are severely limited. Those affected are primarily dependent on a quick diagnosis with subsequent treatment so that further complications and a further deterioration of the symptoms cannot occur. As a rule, self-healing cannot occur because it is a genetic disease.
If the patient wishes to have children, genetic testing and counseling should definitely be carried out to prevent the syndrome from recurring. In general, those affected by this disease are dependent on regular check-ups and examinations by a doctor. The kidneys and the heart in particular must be checked particularly well and regularly in order to detect damage at an early stage.
Likewise, the person concerned should not drink too much, so as not to unnecessarily burden the kidneys. Stressful or physical activities should also be avoided with this disease to avoid shortness of breath. In most cases, no further follow-up measures are necessary. It cannot be universally predicted whether this syndrome will result in a reduced life expectancy for those affected.
You can do that yourself
In any case, the cardio-renal syndrome requires comprehensive medical evaluation and treatment. The measures that those affected can take themselves depend, among other things, on the cause of the symptoms and the medical treatment.
Basically, the symptoms of the disease can be alleviated by rest and bed rest. In the case of shortness of breath or edema in the limbs, medicinal preparations are also recommended, which can be supported by natural medicine. Those affected should talk to their doctor about this and draw up an individual treatment plan. Changing your diet is also useful. Patients should eat healthily and avoid stimulants such as alcohol or nicotine.
In order to support kidney function, you should drink enough. In addition to mineral water, herbal tea and diluted fruit spritzers are also available. If there is a surplus, the drinking quantity must be reduced. In severe cases, diuretics must be taken. Natural remedies such as asparagus or carrot juice can also promote the urge to urinate and thus help alleviate the symptoms. If these measures have no effect, you must go to a doctor with your complaints.