Introduction:
Hemodynamic-guided heart failure management when compared with traditional clinical methods is a better strategy to decrease hospitalization secondary to decompensation. The CardioMEMS HF system (Abbott, CA, USA) is a sensor for measuring pulmonary artery pressures as a surrogate marker of left ventricular filling pressures and has shown benefit in patients with heart failure. Volume management in patients with nephrotic syndrome is challenging and often patients need hospitalizations for close monitoring and diuretics titration. Benefit of a hemodynamic-guided care approach is undetermined in the setting of nephrotic syndrome. We report a patient with membranous nephropathy and overt nephrotic syndrome whose volume status was successfully managed after placement of CardioMEMS.
Methods:
Case description: A 63 year old female with a history of hypertrophic cardiomyopathy (HOCM) and hypothyroidism who developed anasarca was found to have 9 g/d of proteinuria with serum albumin of 1.9 g/dL. Kidney biopsy was consistent with PLA2-negative membranous nephropathy. Workup for secondary causes was negative. She was intolerant to RASi and diuretics in the setting of HOCM. She had multiple hospitalizations with volume overload, bilateral transudative pleural effusions requiring 3 thoracentesis in a span of three months attributed to her severe nephrotic syndrome. CardioMEMS was placed with daily monitoring of pulmonary artery pressures (PAP). Diuretics were titrated based on systolic pulmonary artery pressures with a goal of less than 30 mm Hg. The patient tolerated this well with no further episodes of recurrent pleural effusions or hospitalizations with volume overload over the subsequent three months despite persistent nephrotic syndrome.
Results:
Not Applicable
Conclusions:
Patients with overt nephrotic syndrome could take many months to go into clinical remission and tend to have frequent hospitalizations with anasarca or volume overload. CardioMEMS guided medical management of heart failure has been shown to significantly reduce the number of hospitalizations and overall mortality. However, this is the first case report of use of CardioMEMS for successful volume management in a patient with nephrotic syndrome in the setting of membranous nephropathy. Further studies could provide insight in its use in management of recurrent volume overload in patients with nephrotic syndrome.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.