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
DOI:
https://doi.org/10.18203/2349-3291.ijcp20192032Keywords:
Edema, Inferior vena cava index, Inferior vena cava collapsibility index, Nephrotic syndromeAbstract
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.
References
Priya Pais, Ellis D. Avner. Nephrotic Syndrome. Nelson textbook of pediatrics. 20th ed. Philadelphia: Elsevier; 2016:2521.
Donmez O, Mir S, Ozyiirek R, Cura A, Kabasakal C. Inferior vena cava indices determine volume load in minimal lesion nephrotic syndrome. Pediatr Nephrol. 2001;16:251-5.
Siddal EC, Radhakrishnan J. The pathophysiology of edema formation in the nephrotic syndrome. Kidney Int. 2012;82(6):635-42.
Kosiak W, Swieton D, Piskunowicz M. Sonographic inferior vena cava/aorta diameter index, a new approach to the body fluid status assessment in children and young adults in emergency ultrasound-preliminary study. Am J Emerg Med. 2008;26(3):320-5.
Kitakule MM, Mayo P. Use of ultra sound to assess fluid responsiveness in the intensive care unit. Open Critical Med J. 2010;3:33-7.
Chen L, Kim Y, Santucci KA. Use of ultrasound measurement of the inferior vena cava diameter as an objective tool in the assessment of children with clinical dehydration. Acad Emerg Med. 2007;14(10):841-5.
Chen L, Hsiao A, Langhan M, Riera A, Santucci KA. Use of bedside ultrasound to assess degree of dehydration in children with gastroenteritis. Acad Emerg Med. 2010;17(10):1042-7.
Sönmez F, Mir S, Özyürek AR, Cura A. The adjustment of post-dialysis dry weight based on non-invasive measurements in children. Nephrol Dial Transplant. 1996;11(8):1564-7.
Jaeger JQ, Mehta RL. Assessment of dry weight in hemodialysis: an overview. J Am Soc Nephrol. 1999;10(2):392-403.
Kaptein MJ, Kaptein EM. Focused real-time ultrasonography for nephrologists. Int J Nephrol. 2017;2017:3756857:1-15.
Sridhar H, Mangalore P, Chandrasekaran VP, Manikam R. Caval aorta index and central venous pressure correlation in assessing fluid status!“Ultrasound Bridging the Gap”. ISRN Emerg Med. 2012;2012.
Blehar DJ, Resop D, Chin B, Dayno M, Gaspari R. Inferior vena cava displacement during respirophasic ultrasound imaging. Crit Ultrasound J. 2012 Dec;4(1):18.
Ozdemir K, Mir MS, Dincel N, Bozabali S, Bulut IK, Yilmaz E et al. Bioimpedance for assessing volume status in children with nephrotic syndrome. Turk J Med Sci. 2015;45:339-44.
Nalcacioglu H, Ozkaya O, Baysal K, Kafali HC, Avci B, Tekcan D, et al. 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. Nefrologia. 2018 Jan 1;38(1):48-56.
Ghaffari S, Malaki M, Ghaffari MR, Asiaie K. Inferior Vena Cava Index in Edematous Patients. J Cardiovasc Thoracic Res. 2012;4(3):69-71.
Tabel Y, Mungan I, Karakurt C, Kocak G, Gungor S. Is edema in minimal change disease of childhood really hypovolemic?. Int Urol Nephrol. 2008;40(3):757-61.
