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4.5 Heart/kidney interactions
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Published:July 2018
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Abstract
The interactions between the heart and the kidney are manifold but relate predominantly to haemodynamic and regulatory functions. The kidneys are intricately involved in electrolyte balance, volume homeostasis, and blood pressure regulation through modifying effects on regional haemodynamics and hormonal regulation affecting the heart and other organs. Alterations in cardiac output induced by a variety of clinical conditions can have a profound impact on perfusion of vital organs, including the kidneys, potentially resulting in a vicious cycle referred to as cardiorenal syndrome with high mortality if not treated appropriately. Communication between the kidney and the heart occurs at multiple levels including the sympathetic nervous system, the renin–angiotensin–aldosterone system, antidiuretic hormone, nitric oxide, endothelin, and the natriuretic peptides. The role of renal sympathetic efferent and afferent sensory nerves in modulating renal and cardiac function are of particular importance. Stimulation of the renal sympathetic efferent nerves causes renin release, sodium retention, and reduced renal blood flow, all hallmarks of the renal manifestations of heart failure and the cardiorenal syndrome. Elevated afferent renal sensory nerve signalling increases sympathetic drive via central integration in the hypothalamic region, thereby mediating an increase in sympathetic outflow directed to various regions including the skeletal muscle vasculature, the kidneys, and the heart, which contributes substantially to elevated peripheral vascular resistance, vascular remodelling, and left ventricular hypertrophy as well as accelerating the decline of left ventricular function.
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