{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T21:53:05Z","timestamp":1777240385445,"version":"3.51.4"},"reference-count":73,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2021,6,22]],"date-time":"2021-06-22T00:00:00Z","timestamp":1624320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Cardiorenal syndrome (CRS) is defined as a disorder resulting from the abnormal interaction between the heart and kidney, in which acute or chronic dysfunction of one organ may lead to acute and\/or chronic dysfunction of the other. The functional interplay between the heart and kidney is characterized by a complex bidirectional symbiotic interaction, regulated by a wide array of both genetic and environmental mechanisms. There are at least five known subtypes of CRS, based on the severity of clinical features and the degree of heart\/renal failure. The fourth subtype (cardiorenal syndrome type 4 (CRS4)) is characterized by a primary chronic kidney disease (CKD), which in turn leads to a decreased cardiac function. Impairment of renal function is among the most important pathophysiological factors contributing to heart failure (HF) in the pediatric age group, and cardiovascular complications could be one of the most important causes of mortality in pediatric patients with advanced CKD. In this context, a loss of glomerular filtration rate directly correlates with both the progression of cardiovascular complications in CRS and the risk of HF. This review describes the interaction pathways between the heart and kidney and the recently identified pathophysiological mechanisms underlying pediatric CRS, with a special focus on CRS4, which encompasses both primary CKD and cardiovascular disease (CVD).<\/jats:p>","DOI":"10.3390\/children8070528","type":"journal-article","created":{"date-parts":[[2021,6,22]],"date-time":"2021-06-22T13:02:10Z","timestamp":1624366930000},"page":"528","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Update on the Classification and Pathophysiological Mechanisms of Pediatric Cardiorenal Syndromes"],"prefix":"10.3390","volume":"8","author":[{"given":"Giorgia","family":"Ceravolo","sequence":"first","affiliation":[{"name":"Unit of Emergency Pediatric, Department of Human Pathology in Adult and Developmental Age \u201cGaetano Barresi\u201d, University of Messina, \u201cG. Martino\u201d Policlinic, 98124 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tommaso La","family":"Macchia","sequence":"additional","affiliation":[{"name":"Unit of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, \u201cG. Martino\u201d Policlinic, 98124 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caterina","family":"Cuppari","sequence":"additional","affiliation":[{"name":"Unit of Emergency Pediatric, Department of Human Pathology in Adult and Developmental Age \u201cGaetano Barresi\u201d, University of Messina, \u201cG. Martino\u201d Policlinic, 98124 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valeria","family":"Dipasquale","sequence":"additional","affiliation":[{"name":"Unit of Emergency Pediatric, Department of Human Pathology in Adult and Developmental Age \u201cGaetano Barresi\u201d, University of Messina, \u201cG. Martino\u201d Policlinic, 98124 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7421-0903","authenticated-orcid":false,"given":"Antonella","family":"Gambadauro","sequence":"additional","affiliation":[{"name":"Unit of Emergency Pediatric, Department of Human Pathology in Adult and Developmental Age \u201cGaetano Barresi\u201d, University of Messina, \u201cG. Martino\u201d Policlinic, 98124 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Celeste","family":"Casto","sequence":"additional","affiliation":[{"name":"Unit of Emergency Pediatric, Department of Human Pathology in Adult and Developmental Age \u201cGaetano Barresi\u201d, University of Messina, \u201cG. Martino\u201d Policlinic, 98124 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Domenica","family":"Ceravolo","sequence":"additional","affiliation":[{"name":"Unit of Emergency Pediatric, Department of Human Pathology in Adult and Developmental Age \u201cGaetano Barresi\u201d, University of Messina, \u201cG. Martino\u201d Policlinic, 98124 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maricia","family":"Cutrupi","sequence":"additional","affiliation":[{"name":"Unit of Emergency Pediatric, Department of Human Pathology in Adult and Developmental Age \u201cGaetano Barresi\u201d, University of Messina, \u201cG. Martino\u201d Policlinic, 98124 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Pia","family":"Calabr\u00f2","sequence":"additional","affiliation":[{"name":"Unit of Pediatric Cardiology, Department of Human Pathology in Adult and Developmental Age \u201cGaetano Barresi\u201d, University of Messina, \u201cG. Martino\u201d Policlinic, 98124 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3520-915X","authenticated-orcid":false,"given":"Paola","family":"Borgia","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2815-6288","authenticated-orcid":false,"given":"Gianluca","family":"Piccolo","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, 16132 Genoa, Italy"},{"name":"Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessio","family":"Mancuso","sequence":"additional","affiliation":[{"name":"Unit of Emergency Pediatric, Department of Human Pathology in Adult and Developmental Age \u201cGaetano Barresi\u201d, University of Messina, \u201cG. Martino\u201d Policlinic, 98124 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Remo","family":"Albiero","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sondrio General Hospital, 23100 Sondrio, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Chimenz","sequence":"additional","affiliation":[{"name":"Unit of Pediatric Nephrology, and Rheumatology with Dialysis, Department of Human Pathology in Adult and Developmental Age \u201cGaetano Barresi\u201d, University of Messina, \u201cG. Martino\u201d Policlinic, 98124 Messina, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,22]]},"reference":[{"key":"ref_1","first-page":"43","article-title":"Cardiovascular complications in children with chronic kidney injury","volume":"34","author":"Meo","year":"2020","journal-title":"J. Biol. Regul. Homeost. 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