Since the proposal of cardio-renal syndrome, which describes diseases that involve both heart failure (HF) and acute or chronic kidney disease (CKD), kidney damage has become a topic of discussion in patients with acute HF (AHF). However, the mechanisms and pathophysiology of acute kidney injury (AKI) in AHF patients are multi-factorial and still poorly understood. We first reported AKI on admission in patients with AHF. AKI was found to be already involved in approximately 30% of patients with AHF, with the rate increasing to around 70% over the course of hospitalization. Our findings further suggested that the presence of AKI on admission, especially the exacerbation of AKI at admission, was associated with a poor prognosis. We devised the biomarker strategy to detect the AKI on admission and predict the AKI during acute phase. In these reports, the serum HFABP level can detect the AKI on admission and the urinary LFABP level was useful for the prediction of AKI during the acute phase of AHF in CKD patients. AKI on admission was reported to be caused by venous congestion, and subsequent worsening of AKI during treatment has been suggested to be due to renal proximal tubular injury. Based on the different mechanism of AKI, we can detect the AKI on admission and predict the exacerbation of AKI in AHF by these biomarkers.
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