Point-of-Care Ultrasound (POCUS) in Metastatic Ovarian Carcinoma: Kidney Injury and Inferior Vena Cava (IVC) Compression

Document Type

Conference Proceeding

Publication Date

11-1-2023

Publication Title

J Am Soc Nephrol

Abstract

Introduction: Acute renal failure in metastatic cancer is common, with various causes. Point-of-care ultrasound (POCUS) aids in identifying complications like pleural effusions, edema, and thrombosis. Its utilization is validated both inpatient and outpatient, enhancing diagnostic capabilities at the bedside. Case Description: A 65-year-old female with active metastatic serous ovarian carcinoma of Müllerian origin presented with progressive dyspnea on exertion and lower extremity edema over one month. Her treatment history included Doxil/Bevacizumab with partial response, followed by Carboplatin/Taxol/Avastin and Niraparib with disease progression. Surgical intervention was not an option. Vital signs were significant for tachycardia. Physical examination findings included diminished lung sounds in the left base, distended abdomen, and 3+ pitting edema up to the knees bilaterally. Laboratory workup showed acute kidney injury with creatinine 2.11 mg/dL (baseline 0.9-1.0 mg/ dL) that had been gradually increasing over 6 months. Urinalysis revealed >300 mg/dL protein with a urine protein-to-creatinine ratio of 1.44 g/g. CT chest ruled out pulmonary embolism but revealed a moderate to large left pleural effusion. Intravenous diuretic therapy initially improved symptoms, but renal function subsequently worsened. POCUS demonstrated a patent but collapsible inferior vena cava (IVC) and an abdominal mass compressing the IVC. MRI confirmed flattening of the IVC throughout the abdomen with slit-like narrowing at the level of renal veins, attributed to mass effect from a large left hemiabdominal mass displacing bowel loops. Creatinine stabilized at 1.9 mg/dL, and the patient was discharged with daily furosemide for symptom management and volume status optimization. Discussion: Acute kidney injury due to metastatic mass compression of the IVC is an uncommon but important complication to consider. Compression of the IVC by an abdominal mass can contribute to renal impairment and venous congestion. POCUS is a valuable tool for assessing the IVC and identifying IVC compression, CT or MRI can provide further confirmation. In such cases, diuretic therapy should be used judiciously, with careful consideration of the patient's renal function and overall clinical status. Management of edema and venous congestion in such cases should focus on optimizing volume status and providing symptomatic relief.

Volume

34

First Page

465

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