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For further information, see CMDT Part 22-11: Cardiorenal Syndrome

Key Features

  • Defined as a pathophysiologic disorder of the heart and kidneys wherein the acute or chronic deterioration of one organ results in the acute or chronic deterioration of the other

  • Classified into five types

    • Type 1 consists of acute kidney injury (AKI) stemming from acute cardiac disease

    • Type 2 is chronic kidney disease (CKD) due to chronic cardiac disease

    • Type 3 is acute cardiac disease as a result of AKI

    • Type 4 is chronic cardiac decompensation from CKD

    • Type 5 consists of heart and kidney dysfunction due to other acute or chronic systemic disorders (such as sepsis)

Clinical Findings

  • Cardiac dysfunction: acute or chronic heart failure, ischemic injury, or arrhythmias

  • Kidney disease: acute or chronic, depending on the type of cardiorenal syndrome


  • Evaluate cardiac status with applicable studies, such as BNP, ECG, and echocardiogram

  • Evaluate kidney status with applicable studies, such as

    • BUN; serum creatinine, serum electrolytes, serum bicarbonate

    • Complete blood count

    • Urine microscopy

    • Fractional excretion of sodium or FENa = (urineNa/serumNa)/(urineCr/serumCr) × 100%

    • FENa is high (> 1%) in acute tubular necrosis

    • Renal ultrasound


  • Achieving euvolemia is the overarching therapeutic goal

  • Treat primary underlying heart or kidney dysfunction

  • Medical diuresis achieves similar decongestion with lower rates of adverse events compared to extracorporeal therapy (eg, ultrafiltration)

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