A VExUS Perspective on Cardiorenal Syndrome: Case Report and Literature Review

By Kristi SALIAJ, Elvana RISTA, Maksim CELA

Abstract
Cardiorenal syndrome has long been attributed to reduced cardiac output and renal hypoperfusion, but contemporary evidence increasingly identifies venous congestion as a primary driver of acute kidney injury, particularly in right-sided heart disease. The Venous Excess Ultrasound Score (VExUS) offers an innovative, non-invasive,organ-specific Doppler method to quantify systemic venous hypertension and better define the hemodynamic contributors of renal dysfunction. We report a case illustrating this paradigm, in which decompensated right-sided heart-failure led to high-grade venous congestion on VExUS assessment and resulted in acute kidney injury that improved with targeted decongestive therapy. This case underscores the
growing relevance of VExUS as a practical bedside tool for diagnosing congestion mediated renal injury and guiding individualized fluid management in cardiorenal patients.