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In the kidneys, cells within the proximal convoluted tubules (PCT) and the collecting ducts secrete hydrogen ions (H+) into the tubular fluid. Specifically, in the PCT, Na+/H+ antiporters secrete H+ while reabsorbing Na+.
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In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
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As primary excretory organs, the kidneys maintain homeostasis by removing waste substances from the bloodstream. They comprise over a million units called nephrons, which serve as the kidney's functional units.
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The renin-aldosterone system is an endocrine system which guides the renal absorption of water and electrolytes, thus managing blood pressure and osmoregulation. Activation of the system begins in the kidneys with a small cluster of cells adjacent to the afferent and efferent blood vessels of the renal corpuscle. As the nephrons are filtering blood, juxtaglomerular cells monitor blood pressure. If they detect a decrease in pressure, they release the hormone renin into the bloodstream.
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VExUS Protocol Along Cardiorenal Syndrome: An Updated Review.

Amelia Campos-Sáenz de Santamaría1,2, Zoila Stany Albines Fiestas2,3, Silvia Crespo-Aznarez1,2

  • 1Internal Medicine Department, Hospital Clínico Lozano Blesa, 50009 Zaragoza, Spain.

Journal of Clinical Medicine
|February 26, 2025
PubMed
Summary

The Venous Excess Ultrasound (VExUS) score helps assess fluid overload in heart failure patients. Guiding treatment with VExUS improves decongestion and patient outcomes.

Keywords:
Venous Excess Ultrasoundacute kidney injurycardiorenal syndromechronic kidney diseaseheart failureright atrial pressure

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Area of Science:

  • Cardiology
  • Nephrology
  • Critical Care Medicine

Background:

  • Heart failure (HF) is a primary cause of hospitalizations.
  • Venous congestion in HF frequently leads to acute kidney injury (AKI).
  • Accurate assessment of congestion is crucial for effective HF management.

Purpose of the Study:

  • To review the utility of the Venous Excess Ultrasound (VExUS) score.
  • To analyze recent findings on VExUS in guiding decongestive therapy for acute decompensated HF.
  • To discuss the role of VExUS in cardiorenal patient management.

Main Methods:

  • Comprehensive literature review.
  • Identification of journal articles on VExUS.
  • Manual review of relevant peer-reviewed journals.

Main Results:

  • VExUS score is a valuable bedside tool for assessing venous congestion severity.
  • VExUS demonstrates prognostic value for AKI, HF readmission, and mortality.
  • Therapy guided by VExUS improves the speed of decongestion.

Conclusions:

  • VExUS shows promise for evaluating venous congestion in cardiorenal patients.
  • It enhances fluid and diuretic management through real-time, non-invasive monitoring.
  • Further research is needed to validate VExUS across diverse patient populations, considering operator expertise.