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Kidney Week

Abstract: PO0110

The Emerging Role of Bedside Doppler Ultrasound for Precise Assessment of Venous Congestion in Cardiorenal Syndrome

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Koratala, Abhilash, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
  • Mahmud, Saqib, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
  • Olaoye, Olanrewaju Adebayo, University of Florida, Gainesville, Florida, United States
  • Kazory, Amir, University of Florida, Gainesville, Florida, United States
Introduction

Congestion is an integral component of cardiorenal syndrome and the primary reason for hospitalization in patients with heart failure (HF), making it a key target in the management of these patients. Routinely used parameters to monitor response to decongestive therapy such as physical examination, B-type natriuretic peptide, changes in weight and net fluid balance, even inferior vena cava ultrasound (IVC US) are all error prone. Doppler ultrasonography (DUS) of the portal, hepatic and when possible, intrarenal veins is an attractive alternative that can be used at bedside to accurately assess the degree of congestion and guide management strategies.

Case Description

A 55-year-old man with a history of HF with reduced ejection fraction of ~25%, hypertension and chronic kidney disease stage 3 presented with acute kidney injury of uncertain etiology. Serum creatinine (Scr) was 3.5 mg/dL for a baseline of 1.6 mg/dL. He had no symptoms except for his usual dyspnea on exertion. Physical examination was significant for crackles at lung bases and mild pitting pedal edema. Bedside US revealed increased extravascular lung water and a dilated but collapsible IVC.DUS revealed stigmata of severe congestion with a pulsatile portal vein and systolic flow reversal, and a hepatic vein with only diastolic (D) component below the baseline. Therefore, the diagnosis of congestive renal failure due to acute cardiorenal syndrome was made and high dose intravenous diuretics were initiated. The follow up DUS on days 3 and 5 showed remarkable improvement (reversal of waveforms to normal pattern) indicating progressive decongestion [Figure]. His diuretic therapy was titrated based on these findings and Scr improved to 2 mg/dL at discharge.

Discussion

Bedside DUS assessment of hepatic and portal veins aids in management of patients with HF by non-invasively monitoring the efficacy of decongestive therapy, and serves as a valuable adjunct to conventional clinical evaluation.