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First page of Secondary Cardiorenal Syndromes in Children: Focus on Type 3 to 5 Cardiorenal Syndrome

Background: The interaction between heart and kidneys involves a range of intricate mechanisms and biochemical pathways. This interaction manifests in a clinical state known as cardiorenal syndrome (CRS), which is characterized by sudden or gradual impairment of either the kidney or heart, potentially resulting in acute and/or chronic dysfunction of the other organ. Summary: In 2008, the Acute Dialysis Quality Group introduced a categorization which separated CRS into two primary categories: cardiorenal CRS and renocardiac CRS, based on the primary initiator of disease. Cardiorenal CRS comprises of the first 2 subtypes that are defined as acute and chronic events in which heart failure (HF) causes kidney injury whereas types 3 and 4 are renocardiac CRS characterized by cardiac dysfunction induced by acute kidney injury (AKI) or chronic kidney disease (CKD), respectively. Type 5 CRS is termed as secondary CRS which is defined as structural and functional changes occurring in both the heart and kidney due to an acute systemic disease like sepsis, viral infections, thrombotic microangiopathy, use of drugs, or chronic conditions including diabetes mellitus or systemic amyloidosis. In this review, cardiovascular system involvement in different types of nephrological diseases encountered in the daily practice was overviewed in detail and CRS (with particularly focusing on types 3-5 CRS) in children was explained from a nephrology perspective. Key messages: CRS is frequently seen in children with cardiac, renal, or systemic issues, and poses a significant mortality risk. While this complex disorder is not fully understood, research into its neurohormonal mechanisms may improve management. A collaborative effort among pediatricians, cardiologists, and nephrologists is crucial for developing effective treatment plans to enhance quality of life. Additionally, large-scale studies are needed to explore CRS's complexities and to advance targeted therapies, particularly for pediatric patients, to improve morbidity and mortality outcomes.

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Review Article
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2025
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