Cardiorenal syndrome: Acute kidney injury secondary to cardiovascular disease and role of protein-bound uraemic toxins

© 2014 The Authors. The Journal of Physiology © 2014 The Physiological Society. Cardiovascular disease (CVD) and kidney disease are closely interrelated. Disease of one organ can induce dysfunction of the other, ultimately leading to failure of both. Clinical awareness of synergistic adverse clinica...

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Main Authors: Lekawanvijit S., Krum H.
Format: Review
Published: Wiley-Blackwell 2015
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Online Access:http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=84907876315&origin=inward
http://cmuir.cmu.ac.th/handle/6653943832/38317
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spelling th-cmuir.6653943832-383172015-06-16T07:46:56Z Cardiorenal syndrome: Acute kidney injury secondary to cardiovascular disease and role of protein-bound uraemic toxins Lekawanvijit S. Krum H. Physiology © 2014 The Authors. The Journal of Physiology © 2014 The Physiological Society. Cardiovascular disease (CVD) and kidney disease are closely interrelated. Disease of one organ can induce dysfunction of the other, ultimately leading to failure of both. Clinical awareness of synergistic adverse clinical outcomes in patients with coexisting CVD and kidney disease or 'cardiorenal syndrome (CRS)' has existed. Renal dysfunction, even mild, is a strong independent predictor for poor prognosis in CVD patients.Developing therapeutic interventions targeting acute kidney injury (AKI) has been limited due mainly to lack of effective tools to accurately detect AKI in a timely manner. Neutrophil gelatinase-associated lipocalin and kidney injury molecule-1 have been recently demonstrated to be potential candidate biomarkers in patients undergoing cardiac surgery. However, further validation of AKI biomarkers is needed in other CVD settings, especially acute decompensated heart failure and acutemyocardial infarction where AKI commonly occurs. The other concern with regard to understanding the pathogenesis of renal complications in CVD is that mechanistically oriented studies have been relatively rare Pre-clininal studies have shown that activation of renal inflammation-fibrosis processes, probably triggered by haemodynamic derangement, underlies CVD-associated renal dysfunction. On the other hand, it is postulated that there still are missing links in the heart-kidney connection in CRS patients who have significant renal dysfunction. At present, non-dialysable protein-bound uraemic toxins (PBUTs) appear to be the main focus in this regard. Evidence of the causal role of PBUTs in CRS has been increasingly demonstrated, mainly focusing on indoxyl sulfate (IS) and p-cresyl sulfate (pCS). Both IS and pCS are derived from colonic microbiotic metabolism of dietary amino acids, and hence the colon has become a target of treatment in addition to efforts to improve dialysis techniques for better removal of PBUTs. Novel therapy targeting the site of toxin production has led to new prospects in early intervention for predialysis patients with chronic kidney disease. 2015-06-16T07:46:56Z 2015-06-16T07:46:56Z 2014-01-01 Review 00223751 2-s2.0-84907876315 10.1113/jphysiol.2014.273078 http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=84907876315&origin=inward http://cmuir.cmu.ac.th/handle/6653943832/38317 Wiley-Blackwell
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
topic Physiology
spellingShingle Physiology
Lekawanvijit S.
Krum H.
Cardiorenal syndrome: Acute kidney injury secondary to cardiovascular disease and role of protein-bound uraemic toxins
description © 2014 The Authors. The Journal of Physiology © 2014 The Physiological Society. Cardiovascular disease (CVD) and kidney disease are closely interrelated. Disease of one organ can induce dysfunction of the other, ultimately leading to failure of both. Clinical awareness of synergistic adverse clinical outcomes in patients with coexisting CVD and kidney disease or 'cardiorenal syndrome (CRS)' has existed. Renal dysfunction, even mild, is a strong independent predictor for poor prognosis in CVD patients.Developing therapeutic interventions targeting acute kidney injury (AKI) has been limited due mainly to lack of effective tools to accurately detect AKI in a timely manner. Neutrophil gelatinase-associated lipocalin and kidney injury molecule-1 have been recently demonstrated to be potential candidate biomarkers in patients undergoing cardiac surgery. However, further validation of AKI biomarkers is needed in other CVD settings, especially acute decompensated heart failure and acutemyocardial infarction where AKI commonly occurs. The other concern with regard to understanding the pathogenesis of renal complications in CVD is that mechanistically oriented studies have been relatively rare Pre-clininal studies have shown that activation of renal inflammation-fibrosis processes, probably triggered by haemodynamic derangement, underlies CVD-associated renal dysfunction. On the other hand, it is postulated that there still are missing links in the heart-kidney connection in CRS patients who have significant renal dysfunction. At present, non-dialysable protein-bound uraemic toxins (PBUTs) appear to be the main focus in this regard. Evidence of the causal role of PBUTs in CRS has been increasingly demonstrated, mainly focusing on indoxyl sulfate (IS) and p-cresyl sulfate (pCS). Both IS and pCS are derived from colonic microbiotic metabolism of dietary amino acids, and hence the colon has become a target of treatment in addition to efforts to improve dialysis techniques for better removal of PBUTs. Novel therapy targeting the site of toxin production has led to new prospects in early intervention for predialysis patients with chronic kidney disease.
format Review
author Lekawanvijit S.
Krum H.
author_facet Lekawanvijit S.
Krum H.
author_sort Lekawanvijit S.
title Cardiorenal syndrome: Acute kidney injury secondary to cardiovascular disease and role of protein-bound uraemic toxins
title_short Cardiorenal syndrome: Acute kidney injury secondary to cardiovascular disease and role of protein-bound uraemic toxins
title_full Cardiorenal syndrome: Acute kidney injury secondary to cardiovascular disease and role of protein-bound uraemic toxins
title_fullStr Cardiorenal syndrome: Acute kidney injury secondary to cardiovascular disease and role of protein-bound uraemic toxins
title_full_unstemmed Cardiorenal syndrome: Acute kidney injury secondary to cardiovascular disease and role of protein-bound uraemic toxins
title_sort cardiorenal syndrome: acute kidney injury secondary to cardiovascular disease and role of protein-bound uraemic toxins
publisher Wiley-Blackwell
publishDate 2015
url http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=84907876315&origin=inward
http://cmuir.cmu.ac.th/handle/6653943832/38317
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