Comparison of  the inferior vena cava index and inferior vena cava collapsibility index obtained by ultrasound as a measure of body fluid volume status in children with nephrotic syndrome

Background: There is triad of hypoalbuminemia, edema, and hyperlipidemia in nephrotic syndrome patients. Management of nephrotic syndrome includes general measures like fluid restriction, emergency albumin transfusions and diuretics that provide symptomatic relief till steroids act. These measures require an assessment of body fluid volume to avoid circulatory failure which is very difficult in these patients because of edema. The objective of the study was to measure and compare the Inferior Vena Cava (IVC) Index and Inferior Vena Cava Collapsibility (IVCC) Index by ultrasound as a measure of body fluid volume status in children with nephrotic syndrome.Methods: The present observational study was conducted in all children of age more than 1 year up to 18 year. There were two groups; group 1 was nephrotic syndrome patients-Initial episode or in relapse and group 2 (Control) was age and sex-matched non-nephrotic children. IVC index and IVCC index were measured and compared in both the groups.Results: Mean value of minimum diameter of IVC during inspiration in cases was 5.91±1.60 mm as compared to 4.53±0.94 mm in controls which was significantly higher in case group {P ˂0.0001}. Mean value of IVC index in cases was 0.88±0.20 cm/m2 as compared to 0.93±0.19 cm/m2 in controls which was non-significant. Mean value of IVCC index in cases (35.61±13.68) was significantly less as compared to controls (52.23±2.01) {P ˂0.0001}.Conclusions: The present study concluded that IVCC index is better indicator of body fluid volume status in nephrotic patients as compare to IVC index.

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The role of bioelectrical impedance analysis, NT-ProBNP and inferior vena cava sonography in the assessment of body fluid volume in children with nephrotic syndrome

Nefrología ◽

10.1016/j.nefro.2017.04.003 ◽

2018 ◽

Vol 38 (1) ◽

pp. 48-56 ◽

Cited By ~ 3

Author(s):

Hulya Nalcacioglu ◽

Ozan Ozkaya ◽

Kemal Baysal ◽

Hassan Candas Kafali ◽

Bahattin Avci ◽

...

Keyword(s):

Nephrotic Syndrome ◽

Inferior Vena Cava ◽

Body Fluid ◽

Bioelectrical Impedance Analysis ◽

Inferior Vena ◽

Vena Cava ◽

Bioelectrical Impedance ◽

Impedance Analysis ◽

Body Fluid Volume

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The role of bioelectrical impedance analysis, NT-ProBNP and inferior vena cava sonography in the assessment of body fluid volume in children with nephrotic syndrome

Nefrología (English Edition) ◽

10.1016/j.nefroe.2017.12.001 ◽

2018 ◽

Vol 38 (1) ◽

pp. 48-56

Author(s):

Hulya Nalcacioglu ◽

Ozan Ozkaya ◽

Kemal Baysal ◽

Hassan Candas Kafali ◽

Bahattin Avci ◽

...

Keyword(s):

Nephrotic Syndrome ◽

Inferior Vena Cava ◽

Body Fluid ◽

Bioelectrical Impedance Analysis ◽

Inferior Vena ◽

Vena Cava ◽

Bioelectrical Impedance ◽

Impedance Analysis ◽

Body Fluid Volume

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Inferior Vena Cava Collapsibility Index: A Precise Non-invasive Tool for Evaluation of Edema in Children with Nephrotic Syndrome.

10.21203/rs.3.rs-397289/v1 ◽

2021 ◽

Author(s):

Hanan El-Halaby ◽

Ashraf Bakr ◽

Mohamed El-Assmy ◽

Hussein Abdelaziz Abdalla ◽

Marwa Salem ◽

...

Keyword(s):

Nephrotic Syndrome ◽

Inferior Vena Cava ◽

Inferior Vena ◽

Vena Cava ◽

Fractional Excretion ◽

Volume Status ◽

Non Invasive ◽

Collapsibility Index ◽

Fractional Excretion Of Sodium ◽

Status Assessment

Abstract Evaluating the volume status in children with Idiopathic nephrotic syndrome (INS) is mandatory to guide treatment and avoid unnecessary possibly hazardous albumin use. This study aimed to evaluate and compare the available tools used for volume status assessment and differentiating type of edema in children with INS. Sixty children with active INS were included and subdivided into hypovolemic and non-hypovolemic groups based on fractional excretion of sodium (FeNa%) and clinical assessment. All patients were studied for Inferior vena cava collapsibility index (IVCCI), plasma atrial natriuretic peptide (ANP) concentration and Body composition monitor (BCM). Forty-four patients (77.3%) had non-hypovolemic and 16 (26.7%) had hypovolemic states. Plasma ANP levels didn’t differ between hypovolemic and non-hypovolemic subgroups. IVCCI was higher in hypovolemic group (p<0.001) with sensitivity 87.5% and specificity 81.8% for hypovolemia detection while BCM-over hydration (BCM-OH) values were higher in non-hypovolemic group (p=0.04) with sensitivity= 68.2% and specificity =75% for detection of hypervolemia. FeNa% showed negative significant correlation with IVCCI (r= -0.578, p <0.001) and positive significant correlation with BCM-OH (r= 0.33, p=0.018), while FeNa% showed non-significant correlation to plasma ANP concentration (p=0.25). Conclusion: Non-hypovolemic edema is more frequent in edematous INS children than hypovolemic states. IVCCI is a reliable non-invasive bedside tool for evaluating volume status in INS children and is superior to BCM while plasma ANP levels can’t discriminate type of edema in INS.

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Measurement of Inferior Ven Cava Collapsibility Index and Its Correlation to Central Venous Pressure in Adult Critically Ill Patients a Prospective Observational Study

Journal of Anesthesia & Pain Medicine ◽

10.33140/japm.05.01.09 ◽

2020 ◽

Vol 5 (1) ◽

Keyword(s):

Inferior Vena Cava ◽

Central Venous Pressure ◽

Inferior Vena ◽

Venous Pressure ◽

Vena Cava ◽

Volume Status ◽

P Value ◽

Central Venous ◽

Collapsibility Index ◽

Status Assessment

Fluid therapy is an essential component part management of critically ill patients. Proper estimation of the amount of needed fluids is of great importance due to the well-established adverse effects of marked negative and positive fluids balance. Central venous pressure has been widely used by ICU physicians for volume status assessment. Several methods have been postulated for volume status assessment, among which is the inferior vena cava collapsibility index. As the inferior vena cava is a thin-walled capacitance vessel that adjusts to the body’s volume status by changing its diameter depending on the total body fluid volume. Giving the fact that bed-side ultrasonographic measurement of inferior vena cava diameters is an available, non-invasive, reproducible and quiet easy-to-learn technique, it can provide a safe and quiet reliable replacement of central venous pressure measurement for assessment of volume status assessment. The aim of this study was to find statistical correlation between central venous pressure and caval index, as a step towards validating the above mentioned replacement. 86 critically ill patients from ICU population were enrolled. Simultaneous measurements of central venous pressure and inferior vena cava collapsibility index were observed and recorded on four sessions. Patients were also grouped based on their mode of ventilation and central venous pressure values in order to compare the strength of correlation between various populations. The results showed that Inferior vena cava collapsibility index has significant inverse correlation with CVP value (r= -85, p value ˂0.001 at 95% CI) and it better correlated with mean arterial blood pressure and lactate clearance as compared to central venous pressure. However it correlated better with CVP in spontaneously breathing patients (r= -0.86, p value ˂0.001) than in mechanically ventilated patients (r= -0.84, p value ˂0.001). Inferior vena cava collapsibility index has shown to correlate better with CVP value in lower values (˂ 10 cmH2O) (r= -0.8, p value ˂0.001) than in higher values (≥ 10 cmH2O) (r= -0.6, p value ˂0.001). In addition, an inferior vena caval collapsibility index cut-off value of 29% was shown to discriminate between CVP values ˂10 cmH2O and values ≥10 cmH2O with high Sensitivity (88.6%) and specificity (80.4%). In conclusion, inferior vena cava collapsibility index has a strong inverse relationship with central venous pressure which is more pronounced at low central venous pressure values. Point-of-care ultrasonographically-measured inferior vena cava collapsibility index is very likely to be a good alternative to central venous pressure measurement with a high degree of precision and reproducibility. However, Wide scale studies are needed to validate its use in different patient populations.

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