Cardiorenal Syndrome: Diagnostic Approaches, Imaging Modalities, and Contemporary Therapeutic Strategies. A Comprehensive Review of the Literature up to 2025

Resumen

Cardiorenal Syndrome (CRS) is a clinical concept that describes the bidirectional and pathological interaction between the heart and the kidney. It is defined as a disorder in which acute or chronic dysfunction of one organ precipitates the dysfunction of the other, underscoring the interconnected nature of the cardiovascular and renal systems. This systematic review (based on 28 studies and following the PRISMA 2020 protocol for literature from 2015 to 2025) concludes that the management of Cardiorenal Syndrome (CRS) has radically evolved, identifying venous congestion (congestive nephropathy) as the main driver of acute renal deterioration. Therapeutically, SGLT2 Inhibitors (SGLT2i) have been consolidated as the cornerstone due to their dual effect (cardiac and renal) that reduces mortality and hospitalizations, and slows the decline of renal function. In diagnosis, the key lies in a multimodal approach that integrates fluid overload biomarkers (CA-125), tubular injury markers (NGAL/KIM-1), and the non-invasive, real-time hemodynamic quantification of organ congestion using the VExUS protocol (POCUS). Despite the robustness of these findings, the biggest clinical challenge is the persistent absence of consensus guidelines for CRS, which propels the future towards precision medicine facilitated by Artificial Intelligence (AI) to improve risk stratification.