Cardiorenal Syndrome results from simultaneous abnormalities of the heart and kidney.1 The disease of the heart or kidney in few cases affect normal kidney or heart respectively resulting in abnormalities. The heart and kidneys are linked together and communicate with each other through various pathways. In this article, we will discuss in detail the various aspects of Cardiorenal Syndrome.

Cardiorenal Syndrome

How Is Cardiorenal Syndrome Defined?

  • Cardio-renal Syndrome- This Syndrome is caused by dysfunctions of the heart and kidneys.
  • Cardiac Disease Causes Renal Dysfunction2- Cardiac disease such as congestive heart failure or myocardial infarction results in lower kidney blood flow. The low kidney blood flow initiates kidney diseases
  • Effects Of Cardiac Or Kidney Dysfunction- Acute or chronic diseases of one organ leads to a dysfunction of the other organ.
  • Hemodynamic Instability- Heart and kidneys maintain hemodynamic stability and supply oxygenated blood to entire body.

Classification of Cardiorenal Syndrome

There Are Three Types Of Cardiorenal Syndrome-

Type 1 or Acute Cardiorenal Syndrome:

  • In this type, there is sudden worsening of cardiac function along with kidney injury.
  • Some of the examples of this type of Cardiorenal Syndrome is acute cardiogenic shock or heart failure

Type 2 or Chronic Cardiorenal Syndrome:

  • In this type, there are chronic disorders of cardiac function resulting in progressive chronic kidney disease.
  • An example of this type of Cardiorenal Syndrome is chronic heart failure

Type 3 or Secondary Cardiorenal Syndrome:

  • In this type, there are both cardiac as well as renal dysfunctions.
  • Examples are diabetes mellitus, sepsis, or lupus

Effects of Cardiorenal Syndrome

Cardio-Renal Syndrome Is Attributed To Following Physiological Abnormalities:

  • Low cardiac output.
  • Increased intra-abdominal and central venous pressures.
  • Decreased kidney blood flow.
  • Gradual worsening of renal function.

Risk Factors of Cardiorenal Syndrome


  • Most often seen in older age
  • Dehydration

Pre-Existing Cardiac Diseases

  • Congestive heart failure
  • Myocardial infarction (heart attack)
  • Cardiomyopathy

Chronic Kidney Diseases

  • Glomerulonephritis

Associated Disease

  • Anemia
  • Diabetes
  • Hypertension

Prescription Medications

  • Anti-inflammatory agents,
  • Diuretics
  • ACE inhibitors

Symptoms of Cardiorenal Syndrome

A. Non-Specific Symptoms of Cardiorenal Syndrome

  • Nausea and vomiting
  • Dizziness
  • Fatigue
  • Weakness
  • Sweating

B. Specific Symptoms of Cardiorenal Syndrome

a. Cardiac Symptoms3

  • Chest pain
  • Short of breath (dyspnea)
  • Palpitation
  • Irregular heart beats

b. Renal (Kidney) Symptoms

  • Low Urine Output
  • Hematuria
  • Flank Pain

Symptoms Caused By Associated Diseases-

  • Diabetes
  • Hypertension
  • Anemia4

Diagnosis of Cardiorenal Syndrome

Lab Test for Kidney Failure

  • Urine Examination
    • Blood in urine
    • Proteinuria
    • Creatinine clearance test
    • Increase urine glucose excretion as in diabetes
  • Blood Examination
    • Increases Blood urea nitrogen and creatinine
    • Low hemoglobin
    • Increase blood glucose
  • Radiological Studies
    • CT scan of kidney
    • Magnetic Resonance Imaging of kidney

Cardiac Dysfunction3

  • Electrocardiogram: Following diseases are diagnosed
    • Arrhythmia
    • Congestive heart failure
    • Cardiomegaly
  • Echocardiogram: Following diseases are diagnosed
    • Arrhythmia
    • Congestive heart failure
    • Cardiomegaly
  • Angiogram
    • Check coronary (heart) and renal (kidney) blood supply

Treatment for Cardiorenal Syndrome5

Kidney Failure

  • Fluid control
  • Correct protein loss
  • Dialysis- For End Stage Renal Disease

Cardiac Dysfunction

  • Cardiac Arrhythmia- List of Anti-Arrhythmic Medications Are As Follows:
    • Amiodarone (Cordarone, Pacerone)
    • Lidocaine
    • Procainamide
    • Quinidine
    • Flecainide
    • Tocainide
    • Bepridil Hydrochloride
  • Congestive Heart Failure
    • Diuretics
    • Digoxin
  • Cardiomyopathy
    • ACE Inhibitors: Useful for protection of cardiac and renal tissues
    • Beta Blocker- Indicated to treat arrhythmia, cardiomegaly and cardiomyopathy
    • Calcium Channel Blocker- Indicated for hypertension, arrhythmia and cardiomyopathy.


1. Cardio-renal syndrome: new perspective in diagnostics.

Iyngkaran P1, Schneider H, Devarajan P, Anavekar N, Krum H, Ronco C.

Semin Nephrol. 2012 Jan;32(1):3-17.

2. When Cardiac Failure, Kidney Dysfunction, and Kidney Injury Intersect in Acute Conditions: The Case ofCardiorenal Syndrome.

Legrand M1, Mebazaa A, Ronco C, Januzzi JL Jr.

Crit Care Med. 2014 May 7. [Epub ahead of print]

3. Cardiorenal syndrome and heart failure.

Reinglas J1, Haddad H, Davies RA, Mielniczuk L.

Curr Opin Cardiol. 2010 Mar;25(2):141-7.

4. Erythropoietin in cardiorenal anemia syndrome.

Fazlibegović E1, Hadziomerović M, Corić S, Babić E, Fazlibegović F.

Bosn J Basic Med Sci. 2006 Nov;6(4):36-41.

5. Management of chronic cardiorenal syndrome.

Attanasio P1, Ronco C, Anker MS, Ponikowski P, Anker SD.

Contrib Nephrol. 2010;165:129-39.

Written, Edited or Reviewed By:


Last Modified On: May 19, 2014

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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