New test to predict which heart failure patients will have BUN and creatinine increased by diuretics

NEW TEST TO PREDICT WHICH 
HEART FAILURE PATIENTS 
WILL HAVE BUN AND 
CREATININE INCREASED BY 
DIURETICS 
Thach Nguyen, Dinh Quang Minh Tri 
BACKGROUND 
 Current management of heart failure (HF) includes 
intravenous or oral diuretic. 
 In many cases, diuretics caused severe increase of 
blood urea nitrogen (BUN) or creatinine level. 
 => Discontinuation of diuretics or even resumption 
of IV fluid 
QUESTIONS 
How to predict which HF patient will develop increase of 
BUN and creatinine or renal failure with diuretic? 
Methods 
 Divided in 2 groups: 
Group 1: conventional treatment. 
Group 2: the new Size and Expansion of the Femoral Vein 
(SEFV) of which the results were shown to the investigators. 
Methods 
Principles on the Size and Expansion of the Femoral 
Vein (SEFV) test 
The first principle: 
 The volume of blood going through the femoral artery 
= returning through the common femoral vein. 
 The size of the femoral artery = the femoral vein. 
 The amount of venous return is lower => edema in the 
lower leg 
Methods 
Principles on the Size and Expansion of the Femoral 
Vein (SEFV) test 
The second principle: 
The size of the femoral vein can change from the same 
size to the femoral artery or to be bigger depending on 
the amount of blood in the intravascular compartment. 
=> Fairly accurate method to assess the arterial and 
venous volume could be achieved. 
Methods 
New Non-Invasive SEFV Test 
 Examinaton the size of the femoral vein and 
its expansion with cough. 
 Check in the coronal plane immediately 
proximal to the bifurcation of the superficial 
and deep femoral artery 
 The size of the femoral vein is a little larger 
than the size of the common femoral artery 
Methods 
New Non-Invasive SEFV Test 
Figure 1. 
Methods 
New Non-Invasive SEFV Test 
Figure 2. 
Methods 
New Non-Invasive SEFV Test 
Figure 3. 
Results 
 25 patients with acute on chronic systolic HF - December 
2015 to May 2016. 
 20/25 patients had abnormal SEFV test. 
 18/20 of these patients did not have increase BUN or 
creatinine. 
 One patient had small femoral vein and only 20mg of 
furosemide brought his creatinine from 0.9mg to 2.0mg 
overnight. 
Conclusions 
 The patients with HF should have the SEFV early and its results 
helped to guide the use of diuretics without causing renal failure 
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