Cardiorenal Syndrome

Cardiorenal syndrome (CRS) is a condition in which kidney disease and heart disease occur simultaneously and progresses rapidly. The disorder itself can start from the heart or kidneys. In the context of renal disease as the cause of the disorder, diseases such as atherosclerosis, arteriosclerosis, endothelial dysfunction, and uremic cardiomyopathy are cardiovascular pathological manifestations of CRS. In cases where heart disease is the primary disease, it is the disturbance of cardiovascular dynamics, neurohormonal activation and inflammatory factors that are involved in the initial deterioration of renal function and progressive kidney disease.The word sepsis was first used more than 2000 years ago in ancient Greek literature, referenced by Homer, Hippocrates, Aristotle, Plutarch, and Galen to describe the breakdown of organic matter. In early 1989, Robert Bone introduced the concept of the “sepsis syndrome” as “a systemic response to a documented or suspected infection and at least one organ dysfunction”; consists of hypothermia/hyperthermia, tachycardia, tachypnea, infection, and end-organ dysfunction due to hypoperfusion.More modern definitions of sepsis are based on the concept of SIRS (Systemic Inflammatory Response Syndrome), a term that describes immune complexes in response to infection and is also used to describe the clinical features associated with that response. The clinical use of SIRS describes a disorder of respiratory rate, heart rate, temperature, and leukocyte count. If there are 2 of the 4 criteria below, SIRS can be established: breaths > 20 breaths per minute or PaCo2 <32 mmHg, pulse rate >90 beats per minute, temperature >38oC or <36oC, and leukocytes >12,000/mm3 or <4,000/mm3. The guidelines state that sepsis is SIRS with suspected or proven infection, whereas severe sepsis describes patients who meet the criteria for sepsis and with organ dysfunction. At its worst, septic shock is defined as “characteristic acute circulatory failure with persistent arterial hypotension (including systolic <90 mmHg, MAP <65 mmHg, or a drastic fall in systolic blood pressure >40 mmHg from baseline systolic pressure after adequate fluid resuscitation). which cannot be explained by any other reason.