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Kidney Week

Abstract: TH-PO082

Carcinoid Tumor Causing Cardiorenal Syndrome

Session Information

  • AKI: Mechanisms - I
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

  • 103 AKI: Mechanisms

Authors

  • Hansen, Zachary Austin, Tulane University, New Orleans, Louisiana, United States
  • Baudy, Adrian J., Tulane University, New Orleans, Louisiana, United States
Introduction

Carcinoid tumors are a rare condition that most commonly occurs in the gastrointestinal tract and presents as flushing, diarrhea, and hypotension. Occasionally, it can develop into carcinoid heart disease causing heart failure. This places patients at risk of developing cardiorenal syndrome (CRS) where dysfunction in the heart causes dysfunction in the kidney. CRS has traditionally been attributed to decreased renal perfusion from left heart failure (LHF) but there is now evidence that venous congestion from right heart failure (RHF) is a major cause and has been termed congestive nephropathy. Here, we describe a previously unreported case of carcinoid heart disease causing right sided cardiorenal syndrome.

Case Description

70 year old male with heart failure (EF 60-65%), tricuspid regurgitation, carcinoid tumor with liver and mesenteric metastases presented with worsening upper and lower extremity edema, abdominal swelling and dyspnea for 1 week. On exam, he was hypotensive and hypoxic with Jugular venous distention, ascites and +3 lower extremity edema. Labs showed creatinine of 3.4 and BUN 144, from a baseline of 1.4 and 40 respectively. Chest x-ray showed bilateral pleural effusions. He was admitted to the ICU and diagnosed with CRS. He was treated with Milrinone, dobutamine and furosemide and initially had good urine output but it decreased over the next two days. Intrarenal venous doppler showed discontinuous waveforms consistent with congestive nephropathy. Diuretics were increased to a maximum daily dose of 320mg furosemide, 10mg metolazone and 500mg acetazolamide as well as norepinephrine, dobutamine and milrinone with minimal improvement in urine output. He was started on CRRT for volume removal, but his clinical condition deteriorated, and he died a few days later.

Discussion

To our knowledge, this is the first reported case of right heart failure causing cardiorenal syndrome as a direct result of carcinoid heart disease. Carcinoid tumors are an uncommon neuroendocrine disorder that rarely affects the heart. Cardiorenal syndrome is a familiar condition but is typically attributed to left rather than right heart failure. This case demonstrates a previously unreported combination of cardiorenal syndrome due to right heart failure caused by carcinoid heart disease. It also emphasizes the difficulty in management and the need for further studies regarding congestive nephropathy from right heart failure.