Intrarenal venous flow in cardiorenal syndrome: a shining light into the darkness
Intrarenal venous flow in cardiorenal syndrome: a shining light into the darkness
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DOI：
10.1002/ehf2.12362
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发表时间：
2018-12-01
影响因子：
3.8
通讯作者：
Nunez, Julio
中科院分区：
文献类型：
--
作者：
de la Espriella-Juan, Rafael;Nunez, Eduardo;Nunez, Julio
本病例报告的目的是评估肾内多普勒超声作为一种无创方法评估急性心力衰竭(AHF)合并肾功能不全时肾内静脉血流(IRVF)的潜在作用。我们报告一例81岁的女性心脏瓣膜病(二尖瓣置换术)，表现为急性失代偿性心力衰竭和伴随的肾功能恶化。除了完整的体格检查、实验室分析和超声心动图，还在基线和利尿剂治疗后48小时评估IRVF。入院时，体格检查和超声心动图显示血管内充血的迹象(颈静脉扩张和下腔静脉严重扩张)。此外，在临床评估中，血清肌酐从1.23 mg/dL显著增加到1.81 mg/dL，没有出现低灌注量的迹象。基线时，肾内多普勒超声显示单相IRVF模式，表明肾间质压力严重升高。积极减充血后，IRVF呈动态变化，由单相变为双相，同时临床参数和肾功能改善(血肌酐从1.81 mg/dL降至1.44 mg/dL)。在这例AHF和WRF患者中，IRVF在积极的减充血后发生了变化，这与临床进展一致。根据这些发现，这项技术可以提供有价值的信息来识别“充血性肾功能衰竭”患者的表型。还需要进一步的研究来证实这一观察结果，并评估这项技术在指导AHF和WRF患者减充血治疗方面的潜在作用。
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.