World J Nephrol Urol

World Journal of Nephrology and Urology, ISSN 1927-1239 print, 1927-1247 online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Nephrol Urol and Elmer Press Inc

Journal website https://www.wjnu.org

Case Report

Volume 9, Number 2, December 2020, pages 40-44

Renal Vein Congestion in Cardiorenal Syndrome Type 1: An Analysis of Two Case Reports From a Hemodynamic Perspective

**Table 1.** Hemodynamics Recorded During Admission for Case 1
Case 1	Day 1	Day 2	Day 3	Day 4	Day 5	Day 6	Day 7	Day 8
Case 1 shows cardiorenal syndrome type 1 primarily due to renal vein congestion. Acute kidney injury occurred in presence of elevated RAP despite adequate CI. Renal function improved with diuresis and maintenance of adequate SVR. Day number corresponds to day of admission. BSA: bovine serum albumin; Hgb: hemoglobin; VO₂: oxygen consumption; HR: heart rate; BP: blood pressure (displayed as systolic/diastolic/mean); RAP: right atrial pressure; PAP: pulmonary pressure (displayed as systolic/diastolic/mean); PCWP: pulmonary capillary wedge pressure; SvO₂: mixed venous oxygen saturation; SaO₂: arterial oxygen saturation; CO: cardiac output; CI: cardiac index; SVR: systemic vascular resistance; PVR: pulmonary vascular resistance; BUN: blood urea nitrogen; IV: intravenous.
BSA	2.2	2.2	2.2	2.2	2.2	(Swan discontinued	(Swan discontinued	(Swan discontinued
Hgb	9.1	8.5	8.4	8.4	8.7
VO₂ (used for Fick calculation)	250	250	250	250	250
HR (day average)	101	111	114	101	114	110	110	88
BP (day average)	116/69/85	92/49/63	132/69/90	153/69/97	134/71/92	113/71/85	124/68/87	105/70/82
RAP	29	26	20	25	20
PAP	70/40/55	74/34/45	97/32/54	80/40/53	67/30/42
PCWP	40	34	32
SvO₂	60	64.4	71.2	63.5	59.8
SaO₂	97	97	96	97	94
CO	5.3	6.6	8.8	6.5	5.9
CI	2.4	3	4	3	2.68
SVR	10.5	5.8	5	11	9.8
PVR	2.8	1.6	2.5
Norepinephrine			2
Milrinone	0.375	0.2	0.2	0.1	Discontinued	Discontinued	Discontinued	Discontinued
Lasix (mg/h)	20	20 (+ 40 mg IV × 1)	20	20	20	10
Chlorothiazide	250 mg IV q12h	250 mg IV q12h	250 mg IV q12h	250 mg IV q12h	250 mg IV q12h
Midodrine	10 mg q6h	10 mg q6h	10 mg q6h	10 mg q6h	10 mg q6h
Intake	712.5	1,408.3		1,551.5	1,747.5	456.3	740	1,080
Output	501	2,460		4,640	6,725	3,305	1,035	900
I/O net	211.5	-1,051		-3,090.5	-4,977.5	-2,848.7	-295	180
Creatinine (mg/dL)	1.9	2.3	2.6	2.6	2.6	2.3	2	1.6
BUN (mg/dL)	12	10	14	16	14	10	8	8

Table 1. Hemodynamics Recorded During Admission for Case 1

Case 1

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day 8

Case 1 shows cardiorenal syndrome type 1 primarily due to renal vein congestion. Acute kidney injury occurred in presence of elevated RAP despite adequate CI. Renal function improved with diuresis and maintenance of adequate SVR. Day number corresponds to day of admission. BSA: bovine serum albumin; Hgb: hemoglobin; VO₂: oxygen consumption; HR: heart rate; BP: blood pressure (displayed as systolic/diastolic/mean); RAP: right atrial pressure; PAP: pulmonary pressure (displayed as systolic/diastolic/mean); PCWP: pulmonary capillary wedge pressure; SvO₂: mixed venous oxygen saturation; SaO₂: arterial oxygen saturation; CO: cardiac output; CI: cardiac index; SVR: systemic vascular resistance; PVR: pulmonary vascular resistance; BUN: blood urea nitrogen; IV: intravenous.

BSA

2.2

(Swan discontinued

Hgb

9.1

8.5

8.4

8.7

VO₂ (used for Fick calculation)

250

HR (day average)

101

111

114

101

114

110

BP (day average)

116/69/85

92/49/63

132/69/90

153/69/97

134/71/92

113/71/85

124/68/87

105/70/82

RAP

PAP

70/40/55

74/34/45

97/32/54

80/40/53

67/30/42

PCWP

SvO₂

64.4

71.2

63.5

59.8

SaO₂

5.3

6.6

8.8

6.5

5.9

2.4

2.68

SVR

10.5

5.8

9.8

PVR

2.8

1.6

2.5

Norepinephrine

Milrinone

0.375

0.2

0.1

Discontinued

Lasix (mg/h)

20 (+ 40 mg IV × 1)

Chlorothiazide

250 mg IV q12h

Midodrine

10 mg q6h

Intake

712.5

1,408.3

1,551.5

1,747.5

456.3

740

1,080

Output

501

2,460

4,640

6,725

3,305

1,035

900

I/O net

211.5

-1,051

-3,090.5

-4,977.5

-2,848.7

-295

180

Creatinine (mg/dL)

1.9

2.3

2.6

2.3

1.6

BUN (mg/dL)

**Table 2.** Hemodynamics Recorded During Admission for Case 2
Case 2	Day 1	Day 2	Day 3	Day 4	Day 5	Day 6	Day 7	Day 8	Day 15
Case 2 shows cardiorenal syndrome type 1 primarily due to low CO. Acute kidney injury occurred in the setting of low CI despite normal RAP. Renal function improved with volume resuscitation and inotropic support. Day number corresponds to day of admission. BSA: bovine serum albumin; Hgb: hemoglobin; VO₂: oxygen consumption; HR: heart rate; BP: blood pressure (displayed as systolic/diastolic/mean); RAP: right atrial pressure; PAP: pulmonary pressure (displayed as systolic/diastolic/mean); PCWP: pulmonary capillary wedge pressure; SvO₂: mixed venous oxygen saturation; SaO₂: arterial oxygen saturation; CO: cardiac output; CI: cardiac index; SVR: systemic vascular resistance; PVR: pulmonary vascular resistance; BUN: blood urea nitrogen; IV: intravenous. ^aVO₂ was based on the patient’s BSA multiplied by 125 mL and mixed venous oxygen saturation obtained from superior vena cava via left internal jugular central venous catheter.
BSA	2.1	2.1	2.1	2.1	2.1	2.1	2.1	2.1	2.1
Hgb	11.9	13	12.3	12	11.5	11	10.9	10.9	10.7
VO₂ (used for Fick calculation)^a	262.5	262.5	262.5	262.5	262.5	262.5	262.5	262.5	262.5
HR (day average)	110	109	100	101	101	91	91	86	75
BP (day average)	140/91/107	166/90/115	127/84/98	114/72/86	134/75/95	130/71/91	135/94/108	150/95/113	147/100/119
RAP	3	3	3	3	3	3	3	3	3
PAP									25/11/16
PCWP									8
SvO₂	54.4	62.1	65.8	77.4	66.1	79.3	68.9	75.2	66
SaO₂	96	97	98	98	97	96	98	96	93
CO	3.9	4.25	4.87	7.81	5.43	10.5	6.09	8.51	6.69
CI	1.857142857	2.023809524	2.319047619	3.719047619	2.585714286	5	2.9	4.05238095	3.19
SVR	26.4	26.3	19.5	10.6	16.9	8.3	17.2	12.9	17.3
PVR									1.2
Milrinone	0.75	0.7	0.7	0.7	0.7	0.7	0.7	0.7	Discontinued
Dobutamine		1	2	2	2	2	2	2	7
Lasix	40 mg IV × 1
Other		IV albumin 25 g × 1					IV albumin 25 g × 1
Intake	709.8	1,941.4	1,617.6	1,602.3	796.1	1,701.1	1,954.5	1,473.5
Output	2,075	925	720	1,800	600	725	Not measured	600
I/O net	-1,365.2	1,016.4	897.6	-197.7	196.1	976.1		873.5
Creatinine (mg/dL)	2.2	2.8	2.5	2.2	2	1.9	1.8	1.6	1.7
BUN (mg/dL)	56	61	62	59	56	51	54	52	49

Table 2. Hemodynamics Recorded During Admission for Case 2

Case 2

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day 8

Day 15

Case 2 shows cardiorenal syndrome type 1 primarily due to low CO. Acute kidney injury occurred in the setting of low CI despite normal RAP. Renal function improved with volume resuscitation and inotropic support. Day number corresponds to day of admission. BSA: bovine serum albumin; Hgb: hemoglobin; VO₂: oxygen consumption; HR: heart rate; BP: blood pressure (displayed as systolic/diastolic/mean); RAP: right atrial pressure; PAP: pulmonary pressure (displayed as systolic/diastolic/mean); PCWP: pulmonary capillary wedge pressure; SvO₂: mixed venous oxygen saturation; SaO₂: arterial oxygen saturation; CO: cardiac output; CI: cardiac index; SVR: systemic vascular resistance; PVR: pulmonary vascular resistance; BUN: blood urea nitrogen; IV: intravenous. ^aVO₂ was based on the patient’s BSA multiplied by 125 mL and mixed venous oxygen saturation obtained from superior vena cava via left internal jugular central venous catheter.

BSA

2.1

Hgb

11.9

12.3

11.5

10.9

10.7

VO₂ (used for Fick calculation)^a

262.5

HR (day average)

110

109

100

101

BP (day average)

140/91/107

166/90/115

127/84/98

114/72/86

134/75/95

130/71/91

135/94/108

150/95/113

147/100/119

RAP

PAP

25/11/16

PCWP

SvO₂

54.4

62.1

65.8

77.4

66.1

79.3

68.9

75.2

SaO₂

3.9

4.25

4.87

7.81

5.43

10.5

6.09

8.51

6.69

1.857142857

2.023809524

2.319047619

3.719047619

2.585714286

2.9

4.05238095

3.19

SVR

26.4

26.3

19.5

10.6

16.9

8.3

17.2

12.9

17.3

PVR

1.2

Milrinone

0.75

0.7

Discontinued

Dobutamine

Lasix

40 mg IV × 1

Other

IV albumin 25 g × 1

Intake

709.8

1,941.4

1,617.6

1,602.3

796.1

1,701.1

1,954.5

1,473.5

Output

2,075

925

720

1,800

600

725

Not measured

600

I/O net

-1,365.2

1,016.4

897.6

-197.7

196.1

976.1

873.5

Creatinine (mg/dL)

2.2

2.8

2.5

2.2

1.9

1.8

1.6

1.7

BUN (mg/dL)