Table 2.

Direct and indirect mechanisms of cardiorenal syndrome type 3.

Direct mechanisms	Systemic immune system	Innate
		Adaptive
	Inflammation, cytokines, and chemokines	TNF-α, IL-1, IL-6, ICAM-1
	Oxidative stress	RNS, ROS
	Apoptosis	Cardiac and renal cells
		Neutrophil infiltration
	SNS and RAAS	Norepinephrine activity, disturbance in myocardial calcium homeostasis, oxygen demand, cardiac myocite apoptosis
Indirect mechanisms	Fluid overload	Systemic edema, cardiac overload, hypertension, pulmonary edema, myocardial dysfunction
	Electrolyte imbalances	Hyperkalemia
		Hyperphosphatemia
		Hypophosphotemia
		Hypermagnesemia
	Acidemia	Alterations in protein structure and function
	Uremic toxins	Myocardial ischemia, pericarditis