@VelezNephHepato @DRsonosRD @NephroP @ebtapper @NephroGuy @msiuba @BissellBrittany @ThinkingCC I use VExUS in Cardiorenal not HRS
Plethoric IVC = high RAP
VExUS = abdominal congestiĂłn. VExUS is to right heart failure what lung ultrasound is to left heart failure.
IVC establishes congestion, in liver disease this is for me enough to skip the 48 hr albumin trial 1/2
Plethoric IVC = high RAP
VExUS = abdominal congestiĂłn. VExUS is to right heart failure what lung ultrasound is to left heart failure.
IVC establishes congestion, in liver disease this is for me enough to skip the 48 hr albumin trial 1/2
@VelezNephHepato @DRsonosRD @NephroP @ebtapper @NephroGuy @msiuba @BissellBrittany @ThinkingCC In heart failure. After congestion is established. I ask if congestion is severe enough to lead to worsening renal function (intracapsular tamponade). VExUS = 3 makes this much more likely than VExUS 1. (Although both scenarios have a plethoric IVC). 2/
@VelezNephHepato @DRsonosRD @NephroP @ebtapper @NephroGuy @msiuba @BissellBrittany @ThinkingCC A scenario where this can help in Cirrhosis is a patient with moderate liver disease and concomitant advanced heart failure. Normal BP and high VExUS tell me this patient’s hemodynamic profile is mainly dictated by heart failure 3/
@VelezNephHepato @DRsonosRD @NephroP @ebtapper @NephroGuy @msiuba @BissellBrittany @ThinkingCC Same scenario but but patient has mild/moderate congestion, and low BP. Then LVOT VTI (to estimate Systolic Volume) becomes very important. High LVOT VTI suggests HRS (vasodilation), Low LVOT VTI points to cariogenic shock or low forward flow as the main driver. 4/
@VelezNephHepato @DRsonosRD @NephroP @ebtapper @NephroGuy @msiuba @BissellBrittany @ThinkingCC Of course I am only talking about hemodynamic AKI. Intrinsic AKI doesn’t care about hemodynamics
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