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[Cardiorenal syndrome: causes, diagnosis and treatment of congestive nephropathy]

Manuel Wallbach1, Stephan von Haehling2, Michael Koziolek3

  • 1Klinik für Nephrologie und Rheumatologie, Universitätsmedizin Göttingen, Deutsches Zentrum für Herz-Kreislauf-Forschung, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland.

Innere Medizin (Heidelberg, Germany)
|May 20, 2025
PubMed

Insights

Congestive nephropathy, a cardiorenal syndrome, stems from venous congestion. Doppler sonography aids diagnosis by assessing intrarenal venous blood flow, with diuretics and SGLT2 inhibitors showing treatment efficacy.

Area of Science:

  • Nephrology
  • Cardiology
  • Radiology

Background:

  • Congestive nephropathy (CN) is a component of cardiorenal syndrome, characterized by venous congestion and neurohormonal activation.
  • Common causes include heart failure, pulmonary arterial hypertension, and specific heart defects.

Purpose of the Study:

  • To outline diagnostic criteria and management strategies for congestive nephropathy.
  • To highlight the role of Doppler sonography in diagnosing CN.

Main Methods:

  • Utilizing Doppler sonography to record intrarenal venous blood flow.
  • Categorizing venous flow patterns: continuous (no congestion), pulsatile (mild), biphasic (moderate), and monophasic (severe).
  • Assessing venous impedance index (VII) and renal venous stasis index (RVSI) as diagnostic markers.

Main Results:

  • Doppler sonography can differentiate between normal and congested renal venous flow.
  • Discontinuous flow patterns (pulsatile, biphasic, monophasic) indicate varying degrees of congestion.
  • VII and RVSI provide additional quantitative measures for CN detection.

Conclusions:

  • Doppler sonography is a key diagnostic tool for congestive nephropathy.
  • Management strategies focus on addressing venous congestion.
  • Loop diuretics and SGLT2 inhibitors are effective in managing venous congestion in CN.

Keywords:
Renal venous stasisReno-cardiac syndromeUltrasonography, DopplerVenous excess ultrasoundVenous impedance

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