Acute Cardiorenal Syndrome in Heart Failure: from Dogmas to Advances

Curr Cardiol Rep. 2020 Sep 10;22(11):143. doi: 10.1007/s11886-020-01384-0.


Purpose of review: This review aims to summarize our current understanding and management strategies of acute cardiorenal syndrome (CRS).

Recent findings: The definition of acute CRS remains debated, in part due to the lack of reliable insights into salt and water handling of the kidneys beyond impairment in glomerular filtration. Protocolized use of loop diuretics to ensure adequate delivery to their target of action, as well as segmental tubular blockade with adjunctive use of thiazide diuretics, acetazolamide, amiloride, or sodium-glucose transporter 2 (SGLT2) inhibitors, may result in more effective natriuresis in patients with acute CRS who exhibit diuretic resistance. Other strategies, such as modulating renal sodium avidity with the use of hypertonic saline, reduction of intra-abdominal pressure, or device-based salt and volume removal, are promising and warrant further investigation. Acute CRS remains a significant contributor of morbidity and mortality for the acute heart failure population. New strategies have challenged current dogmas in our understanding of its pathophysiology, which may lead to potential new treatment approaches.

Keywords: Cardiorenal syndrome; Diuretic resistance; Heart failure; Hypertonic saline; SGLT2 inhibitors; Worsening renal function.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Cardio-Renal Syndrome* / drug therapy
  • Diuretics / therapeutic use
  • Heart Failure* / complications
  • Heart Failure* / drug therapy
  • Humans
  • Kidney Function Tests
  • Sodium Potassium Chloride Symporter Inhibitors


  • Diuretics
  • Sodium Potassium Chloride Symporter Inhibitors