scholarly journals Type-5 Cardiorenal Syndrome (CRS-5): An up to Date

2017 ◽  
Vol 3 (1) ◽  
pp. napoc.5000212
Author(s):  
Luca Di Lullo ◽  
Claudio Ronco ◽  
Mario Cozzolino ◽  
Antonio Selvi ◽  
Francesca Santoboni ◽  
...  
Keyword(s):  
Organ Dysfunction ◽  
Epidemiological Data ◽  
Cardiorenal Syndrome ◽  
Clinical Syndrome ◽  
Cardiovascular Dysfunction ◽  
Therapeutic Approaches

Cardiorenal syndromes (CRS) involve disorders of the heart or kidney whereby one organ dysfunction leads to the dysfunction of another. Five types of CRS are defined. While the first 4 types describe acute/chronic cardiorenal or renocardiac syndromes, type-5 CRS refers to secondary CRS or cardiorenal involvement in systemic conditions and describes the concomitant presence of renal and cardiovascular dysfunction. Type-5 CRS is a recently defined clinical syndrome and complete epidemiological data on this entity are still lacking. In the following review, epidemiological, pathophysiological, clinical, and therapeutic approaches to type-5 CRS will be discussed according to more recent findings.

The role of statins in the management of delirium: Recent advances.

2020 ◽  
Vol 19 ◽  
Author(s):  
Junhui Chen ◽  
Yuhai Wang ◽  
Ximin Hu ◽  
Mingchang Li ◽  
Kun Xiong ◽  
...  
Keyword(s):  
Basic Research ◽  
Clinical Syndrome ◽  
Cerebral Hypoperfusion ◽  
Clinical Effects ◽  
Therapeutic Approaches ◽  
Recent Advances ◽  
Organic Mental Disorder ◽  
Coa Reductase ◽  
Pathophysiologic Mechanisms

Background & Objective: Delirium is a clinical syndrome characterized by a temporary organic mental disorder, as well as abnormal attention and cognition. It is a very common, serious, and costly disease with high misdiagnosis and death/disability rates, especially for older patients after surgery. Several factors, such as systemic neuroinflammation, neurotransmitters, cerebral hypoperfusion and microthrombosis, contribute to the progress of delirium; however, the exact pathophysiologic mechanisms are not well known. Therefore, there are no specific therapeutic approaches that can treat delirium effectively. Statins, as inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, have been identified as potential medications for the treatment of delirium because they can significantly reduce the incidence of delirium. The major objective of current review is to summarize recent advances in the understanding of the effects and mechanisms of statins on delirium. Conclusion: In basic research, statins can alleviate delirium via attenuation of neuroinflammation, neurotransmitters, cerebral hypoperfusion, and microthrombosis, which may highlight their potential clinical application for the treatment of delirium. Despite this, the clinical effects of statins still provoke debate.

scholarly journals Rapid Adsorption of Proinflammatory Cytokines by Graphene Nanoplatelets and Their Composites for Extracorporeal Detoxification

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Yishan Zheng ◽  
Nicholas Pescatore ◽  
Yury Gogotsi ◽  
Boris Dyatkin ◽  
Ganesh Ingavle ◽  
...  
Keyword(s):  
Low Cost ◽  
Surface Characteristics ◽  
Clinical Syndrome ◽  
Graphene Nanoplatelets ◽  
High Morbidity ◽  
Therapeutic Approaches ◽  
Management Options ◽  
Rapid Removal ◽  
Low Cytotoxicity ◽  
Potential Use

Sepsis is a complex clinical syndrome that features excessive release of cytokines and other inflammatory mediators that could lead to organ dysfunction. Despite different treatment and management options, sepsis associated high morbidity and mortality rates remain. This has prompted intensive research into alternative therapeutic approaches such as targeted removal of sepsis related molecules using extracorporeal hemoperfusion. In this study, we explore the use of graphene nanoplatelets (GNP) as low-cost alternative hemosorbents for rapid removal of a broad spectrum of proinflammatory cytokine markers. Firstly, the physical characteristics, cytotoxicity, and cytokine marker adsorption profile of GNP were assessed. The results not only confirmed the surface characteristics of GNP and their ability to rapidly remove cytokine markers, but also indicated a low cytotoxicity towards the hepatic cell line HepG2. GNP were then incorporated into a freestanding flexible GNP-poly(tetrafluoroethylene) film with preserved surface characteristics and cytokine adsorption profile for potential use in hemoperfusion applications.

scholarly journals Acute Liver Failure : Management Update

2017 ◽  
Vol 41 (1) ◽  
pp. 53-59 ◽  
Author(s):  
Md Wahiduzzaman Mazumder ◽  
Fahmida Begum ◽  
ASM Bazlul Karim
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Multidisciplinary Approach ◽  
Clinical Syndrome ◽  
Therapeutic Approaches ◽  
Liver Support ◽  
Bioartificial Liver Support ◽  
Liver Assist Devices ◽  
High Liver ◽  
Proven Benefit

Acute liver failure (ALF) is a rare but challenging clinical syndrome with multiple causes; about 50% of pediatric cases a specific etiology cannot be identified. The course of ALF is variable and the mortality rate is high. Liver transplantation is the only therapy of proven benefit, but the rapidity of progression and the variable course of ALF limit its use. Management requires a multidisciplinary approach and is directed at establishing the etiology where possible and monitoring, anticipating, and managing the multisystem complications that occur in children with ALF. Excellent intensive care is critical in management of patients with ALF. Nonspecific therapies are of unproven benefit. Future possible therapeutic approaches include N-acetylcysteine, hypothermia, liver assist devices, and hepatocyte transplantation. Advances in stem cell research may allow provision of cells for bioartificial liver support. ALF presents many challenging opportunities in both clinical and basic research.Bangladesh J Child Health 2017; VOL 41 (1) :53-59

scholarly journals Multiorgan dysfunction syndrome in feline sepsis: prevalence and prognostic implication

2018 ◽  
Vol 21 (6) ◽  
pp. 559-565 ◽  
Author(s):  
Roberta Troìa ◽  
Giulia Mascalzoni ◽  
Stefano Calipa ◽  
Ilaria Magagnoli ◽  
Francesco Dondi ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Organ Dysfunction ◽  
Prognostic Significance ◽  
Significant Risk ◽  
University Hospital ◽  
Laboratory Evaluation ◽  
Regression Analyses ◽  
Cardiovascular Dysfunction ◽  
Multiorgan Dysfunction ◽  
Multiorgan Dysfunction Syndrome

Objectives The current study was designed to evaluate the prevalence and prognostic significance of multiorgan dysfunction syndrome (MODS) in cats with sepsis. Methods Cats hospitalised in the intensive care unit of a veterinary university hospital with a diagnosis of sepsis were prospectively enrolled and divided according to disease severity and outcome (survivors; non-survivors). The feline acute patient physiological and laboratory evaluation (APPLE) scores were calculated upon admission, as previously described. Specific criteria to identify selected organ dysfunction (hepatic, renal, respiratory, cardiocirculatory, haemostatic) were adapted from the available human and veterinary literature, and evaluated at baseline and at the end of hospital stay. MODS was defined as the presence of at least two dysfunctional organs simultaneously. Non-parametric statistics were used for comparisons. Univariate and multivariate regression analyses to evaluate significant risk factors for death were carried out. Correlations between variables were assessed by the Spearman’s rank correlation coefficient. Significance was set at P <0.05. Results A total of 43 cats with heterogeneous sources of sepsis were included. MODS was identified in 25/43 cats upon admission and in 32/43 cats at the end of hospital stay. Regression analyses showed a significantly elevated odds ratio for mortality for the presence of MODS, renal and cardiovascular dysfunction upon admission, as well as for the number of dysfunctional organs. The latter was the only variable retained by the model from the multivariate binary logistic regression analysis. Significant correlations were documented between the number of dysfunctional organs and the APPLE scores. Conclusions and relevance MODS is a frequent complication of feline sepsis, and is associated with worse outcomes. In particular, renal and cardiovascular dysfunction significantly increase the odds for death. Hence, systematic screening for organ dysfunction is advocated in cats with sepsis.

Abstract 17134: Cardiorenal Syndrome Arising From Chronic Diabetes Causes Maladaptive Carbohydrate Utilisation in the Heart and Kidneys

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Marie A Schroeder ◽  
Antoinette Bugyei-Twum ◽  
Albert Chen ◽  
Albert Tsui ◽  
Michelle Mitchell ◽  
...  
Keyword(s):  
Interstitial Fibrosis ◽  
Statistical Significance ◽  
Lactate Production ◽  
Epidemiological Data ◽  
Cardiorenal Syndrome ◽  
Metabolic Reprogramming ◽  
Whole Body ◽  
Carbohydrate Utilization ◽  
Gk Rats

Clinical and epidemiological data have identified a cardiorenal syndrome (CRS), in which heart and/or kidney failure accelerates dysfunction in the other organ. There is a need for new therapeutics targeting the mechanisms that cause CRS, in order to treat the whole patient. Here, we tested the hypotheses that 1) chronic diabetes (aged Goto-Kakizaki [GK] rats) would yield a model of CRS, and 2) assessing in vivo cardiorenal metabolism using hyperpolarized 13 C MR spectroscopy (MRS) would identify targets for CRS therapy. Statistical significance between GK rats and Wistar controls was considered at P<0.05. Glycated hemoglobin confirmed that GK rats were diabetic at 20 weeks. Forty-week-old GK rats (n=6) developed proteinuria, LV hypertrophy, and pulmonary congestion. Invasive pressure-volume loops (n=5) demonstrated preserved systolic, yet impaired diastolic, function. Histology demonstrated myocyte and glomerular hypertrophy, interstitial fibrosis and glomerulosclerosis. Intravenous infusion of hyperpolarized [1- 13 C]pyruvate (n=4), followed by MRS data acquisition that alternated between heart and kidney, indicated that carbohydrate metabolism was reprogrammed to promote lactate production over oxidation. In the heart, this was evidenced by reduced pyruvate dehydrogenase flux to form 13 C-bicarbonate, increased 13 C-lactate production, and reduced 13 C-alanine production. In the kidney, 13 C-lactate was increased at the expense of 13 C-alanine. Metabolic reprogramming to produce cardiorenal lactate was likely mediated by inflammation: in both organs, macrophage infiltration and expression of toll like receptor 4 protein were increased. Increased expression of renal Pck1 and G6pc mRNA indicated involvement of maladaptive systemic gluconeogenesis in CRS pathogenesis. Normalizing whole-body carbohydrate utilization represents a novel target for therapy of diabetes-induced CRS.

scholarly journals Kidney disease and electrolytes in COVID-19: more than meets the eye

2020 ◽  
Vol 13 (3) ◽  
pp. 274-280 ◽  
Author(s):  
Sol Carriazo ◽  
Mehmet Kanbay ◽  
Alberto Ortiz
Keyword(s):  
Kidney Disease ◽  
Hormone Secretion ◽  
Kidney Injury ◽  
Cardiorenal Syndrome ◽  
Global Perspective ◽  
Therapeutic Approaches ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Global Pandemic ◽  
Acute Kidney Disease ◽  
The Impact

Abstract COVID-19 is a global pandemic fuelled in some countries by government actions. The current issue of Clinical Kidney Journal presents 15 articles on COVID-19 and kidney disease from three continents, providing a global perspective of the impact of severe acute respiratory syndrome coronavirus 2 on electrolytes and different kidney compartments (glomeruli, tubules and vascular compartments) and presenting clinically as a syndrome of inappropriate antidiuretic hormone secretion, acute kidney injury, acute kidney disease, collapsing glomerulopathy and thrombotic microangiopathy, among others, in the context of a brand-new cardiorenal syndrome. Kidney injury may need acute dialysis that may overwhelm haemodialysis (HD) and haemofiltration capabilities. In this regard, acute peritoneal dialysis (PD) may be lifesaving. Additionally, pre-existent chronic kidney disease increases the risk of more severe COVID-19 complications. The impact of COVID-19 on PD and HD patients is also discussed, with emphasis on preventive measures. Finally, current therapeutic approaches and potential future therapeutic approaches undergoing clinical trials, such as complement targeting by eculizumab, are also presented.

scholarly journals Cardiac Resynchronization Therapy in the Cardiorenal Syndrome

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Margot K. Davis ◽  
Sean A. Virani
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Cardiac Resynchronization Therapy ◽  
Cardiorenal Syndrome ◽  
Clinical Syndrome ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Patients With Heart Failure ◽  
Potential Risks ◽  
The Impact

The cardiorenal syndrome (CRS) is a complex clinical syndrome in which dysfunction of either the heart or the kidneys affects the functioning of the other organ system. Many therapies used in heart failure have further detrimental effects on renal function. Cardiac resynchronization therapy (CRT) is a relatively new form of device therapy that reduces morbidity and mortality in patients with heart failure. This review will discuss the effects of CRT on renal function in patients with CRS, the impact of baseline renal function on response to CRT, and potential risks associated with CRT in this unique population.

scholarly journals Immunomodulatory Approaches in Diabetes-Induced Cardiorenal Syndromes

2021 ◽  
Vol 7 ◽  
Author(s):  
Lama A. Ammar ◽  
Mohamad I. Nahlawi ◽  
Nizar W. Shayya ◽  
Hilda E. Ghadieh ◽  
Nadim S. Azar ◽  
...  
Keyword(s):  
Immune System ◽  
Drug Targets ◽  
Cardiorenal Syndrome ◽  
Normal Function ◽  
The Other ◽  
Renal Diseases ◽  
Therapeutic Approaches ◽  
Innovative Drug ◽  
And Oxidative Stress ◽  
Feedback Pathways

Immunomodulatory approaches are defined as all interventions that modulate and curb the immune response of the host rather than targeting the disease itself with the aim of disease prevention or treatment. A better understanding of the immune system continues to offer innovative drug targets and methods for immunomodulatory interventions. Cardiorenal syndrome is a clinical condition that defines disorders of the heart and kidneys, both of which communicate with one another through multiple pathways in an interdependent relationship. Cardiorenal syndrome denotes the confluence of heart-kidney relationships across numerous interfaces. As such, a dysfunctional heart or kidney has the capacity to initiate disease in the other organ via common hemodynamic, neurohormonal, immunological, and/or biochemical feedback pathways. Understanding how immunomodulatory approaches are implemented in diabetes-induced cardiovascular and renal diseases is important for a promising regenerative medicine, which is the process of replacing cells, tissues or organs to establish normal function. In this article, after a brief introduction on the immunomodulatory approaches in diseases, we will be reviewing the epidemiology and classifications of cardiorenal syndrome. We will be emphasizing on the hemodynamic factors and non-hemodynamic factors linking the heart and the kidneys. In addition, we will be elaborating on the immunomodulatory pathways involved in diabetes-induced cardiorenal syndrome namely, RAS, JAK/STAT, and oxidative stress. Moreover, we will be addressing possible therapeutic approaches that target the former pathways in an attempt to modulate the immune system.

scholarly journals Hepatorenal Syndrome or Hepatocardiorenal Syndrome: Revisiting Basic Concepts in View of Emerging Data

2018 ◽  
Vol 9 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Amir Kazory ◽  
Claudio Ronco
Keyword(s):  
Renal Dysfunction ◽  
Hepatorenal Syndrome ◽  
Cardiac Involvement ◽  
Cardiorenal Syndrome ◽  
Therapeutic Approaches ◽  
Beneficial Effects ◽  
Advanced Cirrhosis ◽  
Severe Cirrhosis ◽  
Practical Implications ◽  
Pathophysiologic Mechanisms

Background: Accumulating evidence on the pathophysiology of hepatorenal syndrome has challenged the conventional model of liver-kidney connection. While liver cirrhosis is traditionally considered the origin of a cascade of pathophysiologic mechanisms directly affecting other organs such as the kidney, emerging data point to the heart as the potential mediator of the untoward renal effects. Summary: Herein, we briefly review the often-overlooked contribution of the heart to circulatory dysfunction in hepatorenal syndrome and put forward evidence arguing for the involvement of systemic inflammation and endothelial dysfunction in this setting. The temporality of cardiorenal interactions in hepatorenal syndrome and the observed beneficial effects of portosystemic shunting on these pathways lend further support to the notion that cardiac involvement plays a key role in the development of renal dysfunction in severe cirrhosis. Key Messages: The disturbances traditionally bundled within hepatorenal syndrome could represent a hepatic form of cardiorenal syndrome whereby the liver affects the kidney in part through cardiorenal pathways. This new model has practical implications and calls for a shift in the focus of diagnostic and therapeutic approaches to renal dysfunction in advanced cirrhosis.

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