Acute or chronic dysfunction of the heart or kidneys can cause dysfunction of other organs. This interaction between the heart and kidneys is characterized as cardiorenal syndrome (CRS). Recently, a preponderance of data indicated that venous congestion plays an important role in the combination of renal and cardiac diseases. This review aims to focus on the pathophysiology of venous congestion that leads to renal impairment in heart failure and the use of diuretics or ultrafiltration as decongestive therapy in CRS. We found that although clinical studies have confirmed that decongestive therapy has a definite role in decreasing volume overload and the consequent symptom improvement in patients with CRS, the impact of diuretics or ultrafiltration on the improvement of kidney function or mortality remains uncertain. A precise assessment of volume status is required to determine the adequacy of decongestion. Objective measures of renal venous congestion may be a future metric to assess the adequacy of the diuretic response in patients and guide therapeutic decision making.

中文翻译：

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心肾综合征的病理生理学和使用利尿剂和超滤作为容量控制。

心脏或肾脏的急性或慢性功能障碍可导致其他器官功能障碍。心脏和肾脏之间的这种相互作用被称为心肾综合征 (CRS)。最近，大量数据表明静脉充血在肾脏和心脏疾病的合并中起着重要作用。本综述旨在关注导致心力衰竭肾功能损害的静脉充血的病理生理学，以及利尿剂或超滤作为 CRS 的充血疗法的使用。我们发现，虽然临床研究证实减充血疗法在减少 CRS 患者容量超负荷和随之而来的症状改善方面具有明确作用，但利尿剂或超滤对改善肾功能或死亡率的影响仍不确定。需要对容量状态进行精确评估，以确定缓解充血的充分性。肾静脉充血的客观测量可能是未来评估患者利尿剂反应充分性和指导治疗决策的指标。