A 72 year old man presents to the emergency department with dyspnea and worsening leg edema. He is known to have heart failure with preserved ejection fraction and some pulmonary hypertension. He is admitted to your ward with a diagnosis of congestive heart failure and diuretic therapy is started, resulting in a net negative urine output of about 1.5 L over the first 16 hours. His vital signs are stable and his dyspnea is improved, however his creatinine has risen from 150 umol/l (1.7 mg/dl) to 200 (2.3). He has significant lower extremity edema, but JVP is difficult to discern.
POCUS reveals the following:
LVOT VTI of 32 with LVEF 55%, elnarged LA, RV, RA, TAPSE 19mm
1. IVC Short Axis (SAX)
2. IVC Long Axis (LAX)
3. IVC Clip
4. Lung
5. Portal vein
6. Hepatic vein
7. Intrarenal Doppler
Questions:
a. What is the VExUS Score?
b. Is the patient suffering from pre-renal acute kidney injury? Why or not?
c. What should the next therapeutic move be?