Venous congestion and the kidney in cardiorenal syndrome

7th International Congress of Cardionephrology KARNEF (2025) [pp. 281-284]

AUTHOR(S) / АУТОР(И): Danijela Tasić , Zorica Dimitrijević

Download Full Pdf   

DOI: 10.46793/KARNEF25.293T

ABSTRACT / САЖЕТАК:

Hypervolemia is associated with deterioration of renal function and poor prognosis of patients with cardiorenal syndrome. The term congestive nephropathy is related to a disorder of renal function that occur as a result of venous congestion and poor renal perfusion during cardiorenal interaction. The mechanism of congestive nephropathy is multifactorial and complex. It is not possible to fully assess the true intravascular volume by clinical examination. In the assessment of hypervolemia, various markers are used, which are interpreted carefully and in the context of the clinical picture. Of the visualization methods, the most interesting is Doppler ultrasound for assessing volemia and venous circulation in different clinical circumstances. The Doppler index was created as a sum of points obtained by Doppler examination of the inferior vena cava, portal vein, hepatic and renal veins as a means of assessing the degree of hypervolemia and the burden of kidney congestion. One of the goals in the treatment of congestive nephropathy is the control of kidney function, water and electrolyte homeostasis, and hemodynamic disturbance. Future research will resolve doubts about the criteria for the diagnosis of congestive nephropathy, the mechanism of the disease, its recognition, diagnosis and treatment.

KEYWORDS / КЉУЧНЕ РЕЧИ:

nephropathy, hypervolemia, veins, congestion, diagnostics

REFERENCES / ЛИТЕРАТУРА:

  • Deferrari, G.; Cipriani, A.; la Porta, E. Renal dysfunction in cardiovascular diseases and its consequence J. Nephrol. 2021; 34: 137–153
  • Verbrugge, F.H.; Guazzi, M.; Testani, J.M.; Borlaug, B.A. Altered Hemodynamics and End-Organ Damage in Heart Failure. Circulation 2020; 142: 998–1012
  • Fudim, M.; Hernandez, F.; Felker, G.M. Role of Volume Redistribution in the Congestion of Heart Failure. J. Am. Heart Assoc. 2017; 6. e006817.
  • Tabucanon T, Tang WHW. Right Heart Failure and Cardiorenal Syndrome. Cardiol Clin. 2020;38:185–202.
  • Ljungman S, Laragh JH, Cody Role of the kidney in congestive heart failure. Relationship of cardiac index to kidney function. Drugs 1990;39 Suppl 4:10–21
  • Colombo PC, Doran AC, Onat D, et a Venous congestion, endothelial and neurohormonal activation in acute decompensated heart failure: cause or efect? Curr Heart Fail Rep. 2015;12:215–22
  • Nijst P, Martens P, Dupont M, Tang WHW, Mullens W. Intrarenal fow alterations during transition from euvolemia to intravascular volume expansion in heart failure patients. JACC Heart Fail 2017;5:672–681
  • Tang WH, Kitai T. Intrarenal venous fow: a window into the congestive kidney failure phenotype of heart failure? JACC Heart Fail. 2016;4:683–6
  • Verbrugge FH, Grieten L, Mullens W. Management of the cardiorenal syndrome in decompensated heart failure. Cardiorenal Med. 2014;4:176–88
  • Puzzovivo A, Monitillo F, Guida P et a Renal venous pattern: a New parameter for predicting prognosis in heart failure outpatients. J Cardiovasc Dev Dis 2018;5
  • Webster AC, Nagler EV, Morton RL, Masson Chronic kidney disease. Lancet. 2017;389:1238– 52
  • Masson S, Latini R, Milani V, et a Prevalence and prognostic value of elevated urinary albumin excretion in patients with chronic heart failure: data from the GISSI-Heart Failure trial. Circ Heart Fail. 2010;3:65–72
  • Brinkkoetter PT, Ising C, Benzing T. The role of the podocyte in albumin fltration. Nat Rev Nephrol. 2013;9:328–36.
  • Gofredo G, Barone R, Di Terlizzi V, Correale M, Brunetti ND, Iacoviello M. Biomarkers in Cardiorenal Syndrome. J Clin Med 2021;10:3433.
  • Ahmed A, Rich MW, Sanders PW, Perry GJ, Bakris GL, Zile MR, et a Chronic kidney disease associated mortality in diastolic versus systolic heart failure: a propensity matched study. The American Journal of Cardiology. 2007; 99: 393–398.
  • Fu K, Hu Y, Zhang H, Wang C, Lin Z, Lu H, et a Insights of worsening renal function in type 1 cardiorenal syndrome: from the pathogenesis, biomarkers to treatment. Frontiers in Cardiovascular Medicine. 2021; 8: 76015
  • Javaloyes P, Miró Ò, Gil V, Martín-Sánchez FJ, Jacob J, Herrero P, et a Clinical phenotypes of acute heart failure based on signs and symptoms of perfusion and congestion at emergency department presentation and their relationship with patient management and outcomes. European Journal of Heart Failure. 2019; 21: 1353–1365.
  • Rola P, Haycock K. Venous Congestion-Thinking Critical Care [Internet]. Available from https://criticalcarethoughtsdotcom.files.wordpress.com/2019/04/venous-congestion chapter.pd
  • Galindo P, Gasca C, Argaiz ER, Koratala Point of care venous Doppler ultrasound: Exploring the missing piece of bedside hemodynamic assessment. World J Crit Care Med. 2021 Nov;10(6):310-322. doi:10.5492/wjccm.v10.i6.310
  • Bhardwaj, V.; Vikneswaran, G.; Rola, P.; Raju, S.; Bhat, S.; Jayakumar, A.; Alva, A. Combination of Inferior Vena Cava Diameter, Hepatic Venous Flow, and Portal Vein Pulsatility Index: Venous Excess Ultrasound Score (VEXUS Score) in Predicting Acute Kidney Injury in Patients with Cardiorenal Syndrome: A Prospective Cohort Study. Indian J. Crit. Care Med. 2020, 24, 783–789.