What investigations are recommended to assess the severity of cardiorenal syndrome in a primary care setting?

To assess the severity of cardiorenal syndrome in a primary care setting, the following investigations are recommended:

• Measure serum creatinine and estimate glomerular filtration rate (eGFR): This is essential to evaluate kidney function and detect acute kidney injury or chronic kidney disease, especially in patients with heart failure or other risk factors ²,³.
• Measure N-terminal pro-B-type natriuretic peptide (NT-proBNP): This biomarker helps assess heart failure severity and prognosis; very high levels (>2000 ng/l) warrant urgent specialist assessment ¹.
• Urine albumin-to-creatinine ratio (ACR): To assess kidney damage severity and risk stratification in chronic kidney disease ³.
• Clinical assessment: Detailed history and examination to identify symptoms and signs of heart failure and kidney impairment ¹,².
• Consider renal ultrasound: If there is accelerated CKD progression, haematuria, symptoms of obstruction, family history of hereditary kidney disease, or GFR <30 ml/min/1.73 m2, to investigate underlying causes ³.

These investigations together allow assessment of both cardiac and renal function, enabling risk stratification and guiding management in cardiorenal syndrome within primary care ¹,²,³.