Intrarenal Doppler Ultrasound Renal Venous Stasis Index Correlates With Acute Cardiorenal Syndrome in Patients With Acute Decompensated Heart Failure

Figures

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  Figure 1. (A) Colour Doppler demonstrates parenchymal lobar vessels in the renal cortex. (B) Intrarenal Doppler signal demonstrates monophasic flow and illustrates calculation of the renal venous stasis index: venous no flow time divided by the arterial flow time.

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  Figure 2. Shown is a comparison of percent change in serum creatinine level during acute kidney injury episode relative to baseline creatinine level vs (A) renal venous stasis index (RVSI); (B) cardiac index (CI; L/min per m2); (C) tricuspid annulus plane systolic excursion (TAPSE; cm); and (D) mean arterial blood pressure (MAP; mm Hg).

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  Figure 3. Examples of intrarenal Doppler venous flow patterns: Arterial flow is above the baseline, and venous flow is below the baseline. (A) Continuous venous flow (renal venous stasis index = 0) in an acute coronary syndrome patient without acute kidney injury (AKI). (B) Mildly discontinuous venous flow in a patient with acute decompensated heart failure (ADHF) without AKI. (C) Biphasic flow in a patient with ADHF with stage II AKI. (D) Monophasic flow (renal venous stasis index = 0.82) in an ADHF patient with stage III AKI.

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  Figure 4. Shown is the intrarenal Doppler (IRD) flow in a patient with acute decompensated heart failure at the time of admission (day 0) and after 48 hours of decongestive therapy (day 2). Day 0 IRD shows discontinuous monophasic venous flow indicative of severe congestion. Day 2 IRD shows an improved IRD venous pattern with biphasic flow. The renal venous stasis index (RVSI) decreased from 0.66 to 0.48. This patient had stage I acute kidney injury with a creatinine level rise by 85% over baseline. Weight loss of 4.7 kg was achieved with decongestive therapy, and renal function recovered.