Peter A. McCullough - Textbook of Cardiorenal Medicine

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Cardiorenal medicine is an emerging multidisciplinary field that spans a wide spectrum of disease that affects both the cardiovascular and renal systems. It also uniquely highlights how one organ system can affect the other in both health and disease. Cardiorenal medicine has a stout scientific foothold in epidemiology, pathophysiology, diagnosis, prognosis, and management. The bourgeoning medical literature concerning cardiorenal medicine in these areas is testament to the growing base of new knowledge in this field.

The inaugural edition of Cardiorenal Medicine is the culmination of a bold and ambitious project that sought out experts across the globe to put their thoughts into text, tables, and figures for the reader to learn and gain new insight into this field of medicine. The term cardiorenal medicine harkens for collaboration and for careful understanding that living organisms are organized into systems, and that those systems inter-relate and rely on one another in both health and disease. It also intimates that multisystem disease such as diabetes mellitus greatly influences both organ systems and those changes in turn impact the next phases of disease in both organs. Lastly, cardiorenal medicine implies that in vitro diagnostics and therapeutics are very likely to have clinical implications and, in some cases, direct application to both organs.

This text is a tribute to each and every contributor who is an expert in his or her fields. We are indebted to Springer Publications and their assiduous pursuit of materials for publication with all the sudor of publisher working through a global pandemic. It also commemorates a lifetime of professional dedication and tireless effort by Dr. Claudio Ronco of Vicenza and Padua, Italy. Professor Ronco was the original inspiration for this text and through his vision we are carpe diem or seizing the day of science where cardiologists, nephrologists, intensivists, and primary care physicians can come together in the best interests of medical science for the benefit of their patients and generations to come.

The heart and the kidneys are inextricably linked via hemodynamic, neural, hormonal, and cellular signaling systems. The kidneys are the most vascular organ in the body receiving a quarter of cardiac output at rest despite a distal location from renal arteries branching from the aorta. Thus, follows that kidney disease is strongly associated with cardiovascular illness and in fact, may be considered more than a cardiovascular risk factor and better termed as a cardiovascular risk state. Additionally, when either organ sustains injury or begins to fail, there appears to be a consequential affect on the other organ in either an adaptive or maladaptive response that we now recognize as a cardiorenal syndrome(s) []. This chapter will review the connections between the heart and the kidneys from epidemiological, biological, and clinical perspectives with the aim of gaining greater appreciation for this important interface in both acute and chronic care.