Intrarenal venous flow in cardiorenal syndrome: a shining light into the darkness

Abstract

The aim of this case report is to assess the potential role of intrarenal Doppler ultrasonography as a non‐invasive method to evaluate intrarenal venous flow (IRVF) in acute heart failure (AHF) and concomitant renal dysfunction. We report a case of an 81‐year‐old woman with valvular heart disease (previous mitral valve replacement) that presented with acutely decompensated heart failure and concomitant worsening renal function (WRF). In addition to complete physical examination, laboratory analysis, and echocardiography, IRVF was assessed at baseline and 48 h after the administration of diuretic treatment. At admission, physical examination and echocardiography revealed signs of intravascular congestion (jugular venous distension and severely dilated inferior vena cava). In addition, a significant increase in serum creatinine from 1.23 to 1.81 mg/dL was noted without signs of hypoperfusion at clinical evaluation. At baseline, intrarenal Doppler ultrasonography showed a monophasic IRVF pattern indicating a severely elevated interstitial renal pressure. After aggressive decongestion, a dynamic behaviour was found in IRVF changing from monophasic to biphasic pattern in parallel with an improvement in clinical parameters and renal function (serum creatinine changed from 1.81 to 1.44 mg/dL). In this case of a patient with AHF and WRF, IRVF changed after aggressive decongestion in agreement with clinical evolution. According to these findings, this technique could provide valuable information for identifying patients with a ‘congestion kidney failure’ phenotype. Further studies are needed confirming this observation and evaluating the potential role of this technique for guiding decongestive therapy in patients with AHF and WRF.

Intrarenal Doppler ultrasonography reflects hemodynamics and predicts prognosis in patients with heart failure

“…Intrarenal congestion caused by increased CVP, namely increased right-sided pressure overload, has been one of the main pathophysiologic findings in CRS 10,11,[18][19][20][21] . High CVP, rather than low cardiac output, predetermines the risk of worsening renal function in decompensated HF 10 .…”

Doppler-Derived Intrarenal Venous Flow Mirrors Right-Sided Heart Hemodynamics in Patients With Cardiovascular Disease

“…Patients A mid growing attention to renal congestion in heart failure (HF), evidence is accumulating for Dopplerderived intrarenal venous flow (IRVF) being a reliable and feasible visual biomarker in not only renal circulation assessments but also as a predictor of prognosis in cardiovascular diseases. [1][2][3][4][5][6][7][8] Thus, assessment of IRVF might help guide decongestive therapy, but more detailed information is needed. 9 Changes in IRVF, pulsatility and interruption, are mainly determined by central venous pressure (CVP).…”

Ultrasound imaging of congestion in heart failure: examinations beyond the heart

“…61 Recently, ultrasound techniques to assess renal blood flow in HF have been described. 22,37,45,62 Although renal arterial flow can be assessed with Doppler ultrasound and predicts HF progression, 63 an elevated CVP primarily affects renal venous flow (RVF).…”