Acute cardiorenal syndrome in therapeutic practice: clinical variants and prognosis

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription Access

Abstract

Cardiorenal syndrome (CRS) refers to interrelated pathological conditions involving the heart and kidneys, in which acute dysfunction of one organ leads to acute dysfunction of the other. Currently, CRS is classified into acute and chronic CRS, acute and chronic renocardiac syndrome, and secondary CRS. Hemodynamic, vascular, metabolic, neurohormonal, cytokine, and inflammatory mechanisms contribute to the development of CRS. Growing interest in CRS is associated with the rising incidence of chronic heart failure and chronic kidney disease. The diagnosis of acute CRS involves electrocardiography (focal myocardial changes, conduction and excitability disturbances, myocardial hypertrophy), echocardiography (reduced left and/or right ventricular ejection fraction, regional hypokinesia, assessment of intracardiac hemodynamics and valvular structures, pulmonary artery pressure), vascular ultrasound (assessment of central venous congestion, renal and hepatic venous congestion, presence of free fluid), as well as cardiac and renal biomarkers (troponin I, NT-proBNP, creatinine, cystatin C).

Clinical case. This article presents a clinical case of acute CRS in a young patient triggered by a respiratory infection. ECG revealed conduction abnormalities. Holter monitoring showed frequent episodes of second-degree sinoatrial block (Mobitz type I) with escape atrial and ventricular complexes, along with 42 monomorphic ventricular and 12 supraventricular extrasystoles. During treatment, laboratory parameters demonstrated a decline in inflammatory markers (leukocytes, neutrophils, C-reactive protein, fibrinogen, D-dimer, procalcitonin), lactate dehydrogenase, and NT-proBNP, along with improved kidney function (reduction in creatinine and cystatin C, increase in estimated glomerular filtration rate). Blood levels of troponin I and IL-6 remained within normal ranges.

About the authors

Ilkhom T. Murkamilov

Kyrgyz State Medical Academy named after. I.K. Akhunbaev; Salymbekov University

Author for correspondence.
Email: murkamilov.i@mail.ru
ORCID iD: 0000-0001-8513-9279

Dr.Sci. (Med.), Corresponding Member of the Russian Academy of Natural Sciences, Associate Professor at the Department of Faculty Therapy, Director of the Multidisciplinary Medical Center “Doc University Clinic”

Kyrgyzstan, Bishkek; Bishkek

Kubanych A. Aitbaev

Salymbekov University

Email: aitbaev.kuban1940@gmail.com
ORCID iD: 0000-0003-4973-039X

Dr.Sci. (Med.), Professor, Department of Intensive Care Medicine, Therapy and Diagnostics

Kyrgyzstan, Bishkek

Viktor V. Fomin

Sechenov University

Email: fomin_vic@mail.ru
ORCID iD: 0000-0002-2682-4417

Dr.Sci. (Med.), Professor, Corresponding Member of the Russian Academy of Sciences, Head of the Department of Faculty Therapy No. 1, N.V. Sklifosovsky
Institute of Clinical Medicine, Vice-Rector for Innovation and Clinical Activities

Russian Federation, Moscow

Zafarbek R. Raimzhanov

N.N. Burdenko Main Military Clinical Hospital

Email: rzrmam@mail.ru
ORCID iD: 0000-0001-5746-6731

neurologist at the 29th Neurological Department

Russian Federation, Moscow

Furkat A. Yusupov

Osh State University

Email: furcat_y@mail.ru
ORCID iD: 0000-0003-0632-6653

Dr. Sci. (Med.), Professor, Head of the Department of Neurology, Neurosurgery and Psychiatry, Medical Faculty

Kyrgyzstan, Osh

Tursunoy F. Yusupova

Osh State University

Email: yusupova_tursunoy_f@mail.ru
ORCID iD: 0000-0002-8502-2203

Clinical Resident of the Department of Neurology, Neurosurgery and Psychiatry, Medical Faculty

Kyrgyzstan, Osh

Abdulhokim F. Yusupov

Osh State University

Email: furcat_y@mail.ru

Assistant of the Department of Neurology, Neurosurgery and Psychiatry, Medical Faculty

Kyrgyzstan, Osh

Jaloliddin I. Solizhonov

Kazan State Medical University

Email: jaloliddinsolijonov44@gmail.com
ORCID iD: 0009-0003-0078-0609

6th-year student of the Faculty of Medicine

Russian Federation, Kazan

Komil K. Khabibullaev

Kyrgyz State Medical Academy named after. I.K. Akhunbaev

Email: khabibullaevkomil2001@gmail.com
ORCID iD: 0009-0004-5508-8019

6th-year student of the Faculty of Medicine

Kyrgyzstan, Bishkek

References

  1. Резник Е.В., Никитин И.Г. Кардиоренальный синдром у больных с сердечной недостаточностью как этап кардиоренального континуума (часть I): определение, классификация, патогенез, диагностика, эпидемиология (обзор литературы). Архивъ внутренней медицины. 2019;9(1):5–22. [Reznik E.V., Nikitin I.G. Cardiorenal syndrome in patients with chronic heart failure as a stage of the cardiorenal continuum (part I): definition, classification, pathogenesis, diagnosis, epidemiology. Rus. Arch. Int. Med. 2019;9(1):5–22 (In Russ.)]. https://doi.org/10.20514/2226-6704-2019-9-1-5-22.
  2. Мельник А.А. Кардиоренальный синдром: диагностика и лечение. Почки. 2017;6:1:2–14. [Melnyk O.O. Cardiorenal Syndrome: Diagnosis and Treatment. Kidneys. 2017;6:1:2–4 (In Russ.)]. https://doi.org/10.22141/2307-1257.6.1.2017.93777.
  3. Шутов А.М., Серов В.А. Кардиоренальный континуум или кардиоренальный синдром? Клиническая нефрология. 2010;1:44–8. [Shutov A.M., Serov V.A. Cardiorenal continuum or cardiorenal syndrome? Clinical nephrology.2010;1:44–8 (In Russ.)].
  4. Ronco C. Cardiorenal and renocardial syndromes: clinical discordersinsearch of a systematic definition. Int. J. Artif. Organs. 2008;31(1):1–2. [PMID: 18286448].
  5. Ronco C., Haapio M., House A.A. et al. Саrdiorenal syndrome. J. Am. Coll. Cardiol. 2008;52(19):1527–39. https://doi.org/10.1016/j.jacc.2008.07.051.
  6. Резник Е.В., Никитин И.Г. Кардиоренальный синдром у больных с сердечной недостаточностью как этап кардиоренального континуума (часть 2): прогностическое значение, профилактика и лечение. Архивъ внутренней медицины. 2019;9(2):93–106. [Reznik E.V., Nikitin I.G. Cardiorenal syndrome in patients with heart failure as a stage of the cardiorenal continuum (part 2): prognosis, prevention and treatment. Rus. Arch. Int. Med. 2019;9(2):93–106 (In Russ.)]. https://doi.org/10.20514/2226-6704-2019-9-2-93-106.
  7. Кутырина И.М., Руденко Т.Е., Савельева С.А. и др. Кардиоренальный синдром у больных хронической болезнью почек и сахарным диабетом. Сахарный диабет. 2013;3(60):90–6. [Kutyrina I.M., Rudenko T.E., Savel’eva S.A. et al. Cardiorenal syndrome in patients with chronic kidney disease and diabetes mellitus. Diabetes mellitus. 2013;3(60):90–6. (In Russ.)]. http://dx.doi.org/10.14341/2072-0351-822.
  8. Щекочихин Д.Ю., Копылов Ф.Ю., Козловская Н.Л., Сыркин А.Л. Кардиоренальный синдром при декомпенсированной сердечной недостаточности. Сердечная недостаточность. 2012;13(4):248–52. [Shchekochikhin D.Yu., Kopylov F.Yu., Kozlovskaya N.L., Syrkin A.L. Cardiorenal syndrome in decompensated heart failure. Heart Failure. 2012;13(4):248–52 (In Russ.)].
  9. Муркамилов И.Т., Раимжанов З.Р., Сабирова А.И. и др. C-реактивный белок, скорость клубочковой фильтрации и показатели эхокардиографии у лиц с различными категориями сердечно-сосудистого риска. Бюллютень науки и практики. 2023;9(4):322–48. [Murkamilov I., Raimzhanov Z., Sabirova A. et al. C-reactive Protein, Glomerular Filtration Rate, and Echocardiographic Parameters in Individuals With Different Cardiovascular Risk Categories. Bull. Sci. Pract. 2023;9(4):322–48 (In Russ.)]. https://doi.org/10.33619/2414-2948/89/39.
  10. Муркамилов И.Т., Айтбаев К.А., Фомин В.В. и др. Оценка биомаркеров воспаления и факторы риска сердечно-сосудистых заболеваний при избыточной массе тела и ожирении. Кардиоваскулярная терапия и профилактика. 2024;23(3):3733. [Murkamilov I.T., Aitbaev K.A., Fomin V.V. et al. Assessment of inflammatory biomarkers and risk factors for cardiovascular diseases in overweight and obesity. Cardiovascular Therapy and Prevention. 2024;23(3):3733. (In Russ.)]. https://doi.org/10.15829/ 1728-8800-2024-3733.
  11. Москаленко С.А., Шувалова Ю.А., Каминный А.И. Роль системы интерлейкина-6 в развитии атеросклероза. Атеросклероз и дислипидемии. 2020;2(39):5–11. [Moskalenko S.A., Shuvalova Y.A., Kaminnyi A.I. The role of the Interleukin-6 system in the development of atherosclerosis. Atherosclerosis and dyslipidemia. 2020;2(39):5–11 (In Russ.)]. https://doi.org/10.34687/2219–8202.JAD.2020.02.0001.
  12. Чеботарева Н.В., Виноградов А.А., Гиндис А.А. и др. Нарушение баланса провоспалительных цитокинов и Т-регуляторных клеток у больных хроническим гломерулонефритом. Терапевтический архив. 2020;92(6):46–52. [Chebotareva N.V., Vinogradov A.A., Gindis A.A. et al. The balance of proinflammatory cytokines and Treg cells in chronic glomerulonephritis. Therapeutic archive. 2020;92(6):46–52 (In Russ.)]. https://doi.org/ 10.26442/00403660.2020.06.000671.
  13. Бобкова И.Н., Чеботарева Н.В., Козловская Л.В., Непринцева Н.В. Система самозащиты почки: современный взгляд на механизмы, определяющие течение и исход гломерулонефрита (Обзор литературы). Нефрология и диализ. 2013;15(3):174-83. [Bobkova I.N., Chebotareva N.V., Kozlovskaya L.V., Neprintseva N.V. Kidney self-defense system: modern view on the mechanisms defining a current and an outcome of glomerulonephritis Review. Nephrology and dialysis. 2013;15(3):174–83 (In Russ.)].
  14. Martínez-Montoro J.I., Cornejo-Pareja I., Díaz-López A. et al. PREDIMED‐Plus Investigators. Effect of an intensive lifestyle intervention on cystatin C-based kidney function in adults with overweight and obesity: From the PREDIMED-Plus trial. J. Intern. Med. 2025;297(2):141–55. https://doi.org/10.1111/joim.20038.
  15. Chen Y., Xu F., Li J., Bao Y. A cross-sectional and longitudinal cohort study of creatinine-to-cystatin C ratio and cardiovascular disease risk in a middle-aged and elderly population. Front. Endocrinol. (Lausanne). 2025;16:1531394. https://doi.org/10.3389/fendo.2025.1531394.
  16. Кобалава Ж.Д., Контарева Н.И., Хрулева Ю.В. и др. Альбуминурия как маркер си стемного застоя и предиктор неблагоприятного долгосрочного прогноза при острой декомпенсации сердечной недостаточности. Российский кардиологический журнал. 2024;29(4):5734. [Kobalava Zh.D., Kontareva N.I., Khruleva Yu.V. et al. Albuminuria as a marker of systemic congestion and a predictor of poor long-term prognosis in acute decompensated heart failure. Russian Journal of Cardiology. 2024;29(4):5734 (In Russ.)]. https://doi.org/10.15829/1560 4071-2024-5734.
  17. Кобалава Ж.Д., Сафарова А.Ф., Асланова Р.Ш., Вацик-Городецкая М.В. Почечная венозная допплерография – новый параметр для прогнозирования исходов у пациентов с декомпенсацией хронической сердечной недостаточности. Бюллетень сибирской медицины. 2023;22(2):53–60. [Kobalava Zh.D., Safarova A.F., Aslanova R.Sh., Vatsik-Gorodetskaya M.V. Renal venous Doppler ultrasound – a new parameter for predicting outcomes in patients with decompensated heart failure. Bulletin of Siberian medicine. 2023;22(2):53–6 (In Russ.)]. https://doi.org/10.20538/ 1682-0363-2023-2-53-60.
  18. Сабиров И.С., Муркамилов И.Т., Фомин В.В. Гепатобилиарная система и новая коронавирусная инфекция (COVID-19). The Scientific Heritage.2020;49–2:49–58. [Sabirov I., Murkamilov I., Fomin V. Hepatobiliary system and novel coronavirus infection (COVID-19). The Scientific Heritage.2020;49–2:49–58 (In Russ.)].

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Согласие на обработку персональных данных

 

Используя сайт https://journals.rcsi.science, я (далее – «Пользователь» или «Субъект персональных данных») даю согласие на обработку персональных данных на этом сайте (текст Согласия) и на обработку персональных данных с помощью сервиса «Яндекс.Метрика» (текст Согласия).