Pathophysiological Mechanisms in Cardiorenal Syndrome

Cardiorenal syndrome represents the confluence of intricate hemodynamic, neurohormonal, and inflammatory pathways that initiate and propagate the maladaptive cross talk between the heart and kidneys. Several of these pathophysiological principles were described in older historical experiments. The last decade has witnessed major efforts in streamlining its definition, clinical phenotypes, and classification to improve diagnostic accuracy and deliver optimal goal-directed medical therapies. The ability to characterize the various facets of cardiorenal syndrome based on its pathophysiology is poised in an exciting vantage point, in the backdrop of several advanced diagnostic strategies, notably cardiorenal biomarkers that may help with accurate delineation of clinical phenotype, prognosis, and delivery of optimal medical therapies in future studies. This promises to help integrate precision medicine into the clinical diagnosis and treatment strategies for cardiorenal syndrome and, through a heightened understanding of its pathophysiology, to deliver appropriate therapies that will reduce its associated morbidity and mortality. Cardiorenal syndrome represents the confluence of intricate hemodynamic, neurohormonal, and inflammatory pathways that initiate and propagate the maladaptive cross talk between the heart and kidneys. Several of these pathophysiological principles were described in older historical experiments. The last decade has witnessed major efforts in streamlining its definition, clinical phenotypes, and classification to improve diagnostic accuracy and deliver optimal goal-directed medical therapies. The ability to characterize the various facets of cardiorenal syndrome based on its pathophysiology is poised in an exciting vantage point, in the backdrop of several advanced diagnostic strategies, notably cardiorenal biomarkers that may help with accurate delineation of clinical phenotype, prognosis, and delivery of optimal medical therapies in future studies. This promises to help integrate precision medicine into the clinical diagnosis and treatment strategies for cardiorenal syndrome and, through a heightened understanding of its pathophysiology, to deliver appropriate therapies that will reduce its associated morbidity and mortality. Clinical Summary•Cardiorenal syndrome represents the interplay of several patho-physiological pathways in its pathogenesis.•Notable pathways involved in the genesis of cardiorenal syndrome include elevated central and renal venous pressures, arterial underfilling, elevated intra-abdominal pressures, neuro-hormonal perturbations, and oxidative stress.•Biomarkers of cardiac and kidney injury have the potential to provide important clinical information in the diagnosis and management of cardiorenal syndrome in the future. •Cardiorenal syndrome represents the interplay of several patho-physiological pathways in its pathogenesis.•Notable pathways involved in the genesis of cardiorenal syndrome include elevated central and renal venous pressures, arterial underfilling, elevated intra-abdominal pressures, neuro-hormonal perturbations, and oxidative stress.•Biomarkers of cardiac and kidney injury have the potential to provide important clinical information in the diagnosis and management of cardiorenal syndrome in the future.