**3. Management of the cardiorenal syndrome**

Management of the CRS presents a challenge to the clinician. Treatment of HF with standard therapies often results in worsening of renal function. Moreover, most randomized clinical trials of HF therapies, including β-blockers, ACE inhibitors, ARBs and aldosterone antagonists, have excluded patients with significant renal dysfunction. Therefore, the results of these trials, most showing significant reductions in morbidity and mortality in the general HF population, may not be applicable to the CRS population. Observational studies and small randomized studies, however, have suggested that many of these drug classes may have similar benefit in patients with renal dysfunction (Berger et al., 2007; Cice et al., 2003). A number of novel strategies have been described that may offer specific benefit in the CRS population, although data from clinical trials have not always been encouraging.

Management of chronic CRS is overall similar to the management of HF in general, employing a combination of diuretics, inhibitors of the RAAS, and β-blockers. In the hospitalized patient with CRS and ADHF, diuretics remain a mainstay of therapy, but may be supplemented by additional therapies including novel pharmacologic agents, inotropic support, and ultrafiltration.
