Background: Cardiorenal syndrome (CRS) is a group of pathophysiological disorders affecting heart and kidneys.
Case presentation: We present 44-year-old kidney transplant recipient with acute-on-chronic graft failure in the course of CRS due to acutely decompensated heart failure associated with severe aortic regurgitation successfully treated with aortic valve replacement. Because of graft failure progression and difficult to eradicate infections he was treated with dialysis and radical minimization of immunosuppression. After 74 days of renal replacement therapy the patient regained graft function after successful aortic valve replacement. The dialysis could be stopped and immunosuppressive therapy was reintroduced. Heart and renal function are stable and patient is doing well without dialysis for 3 years.
Conclusions: The return of kidney graft function can occur even after a long period of dialysis therapy due to improved cardiovascular function. Therefore, distinguishing an acute-on-chronic CRS subtype is mandatory to enable specific patient approach.
Keywords: Acute-on-chronic; Aortic insufficiency; Aortic valve replacement; Cardiorenal syndrome; End stage renal disease; Haemodialysis; Heart failure; Kidney transplantation.