Cardiorenal Syndrome in Cardiogenic Shock: Contemporary Pathophysiology, Hemodynamic Principles, and Emerging Therapeutic Strategies.

Authors

Chirag Mehta, Zola Wilkerson, Sarah Bhanushali, Jaydev Dave, Sunit Chhetri, Heena Asnani, Hall Zhang, Victoria Maksymiuk, Bahaa Salama, William H Frishman, Wilbert S Aronow

Published in

Cardiology in review. Aug 31, 2026. Epub Aug 31, 2026.

Abstract

Cardiorenal syndrome (CRS) represents a complex bidirectional interaction between the heart and kidneys whereby acute or chronic failure of one organ precipitates dysfunction in the other. CRS occurring in the setting of cardiogenic shock (CS), or CRS-CS, remains one of the most severe manifestations, contributing substantially to morbidity and mortality. Historically, CRS-CS was attributed to renal hypoperfusion from reduced cardiac output. Contemporary evidence suggests that venous congestion and right ventricular dysfunction play equally important roles in the development of acute kidney injury and resultant CRS-CS. Advanced hemodynamic monitoring has further refined our understanding of this dynamic interplay. This review discusses the epidemiology, pathophysiology, hemodynamic determinants, diagnosis, and contemporary management of CRS-CS, emphasizing the importance of forward flow, venous congestion, and right ventricular performance when evaluating renal dysfunction.

PMID:
42673535
Bibliographic data and abstract were imported from PubMed on 01 Sep 2026.

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