POINT OF CARE ULTRASOUND=POCUS IN ONCONEPHROLOGY : EXPERIENCE AT PITIE SALPETRIERE ONCONEPHROLOGY CLINIC

Introduction:

The links between cancer and the kidneys are close. Kidney function impacts cancer management and conversely, cancer treatment can deteriorate kidney function. Cancer patients, especially those undergoing chemotherapy, are at risk for fluid imbalances. The evaluation of the extracellular volume of cancer patients is a crucial step that will condition the management: hydration versus depletion, discontinuation versus increase in diuretics dosage, alleviation of anti-hypertensive drugs versus intensification. While careful questioning and clinical examination remain key elements in the assessment of extracellular volume, they alone are often not sufficient to accurately assess the fluid status of these patients, who often have significant fluctuations in their weight and muscle mass. Point-of-care ultrasound (POCUS) is increasingly recognized as a valuable tool in onconephrology. POCUS is a bedside ultrasound test that provides quick and effective answers to specific clinical questions. POCUS can quickly assess volume status by visualizing the inferior vena cava (IVC), lungs, and other key areas, helping guide fluid therapy. POCUS can detect acute kidney injury (AKI) and other renal abnormalities like hydronephrosis (swelling of the kidney due to urine buildup), which can be critical in patients with obstructive uropathy (e.g., due to tumors). Moreover, POCUS can guide kidney biopsies, fluid drainage, or other interventional procedures, making them safer and more accurate. It facilitates the placement of central venous catheters or dialysis catheters, which are commonly needed in onconephrology patients. Initially used in emergency departments and intensive care, the POCUS is increasingly used in several fields of medicine. In Onco-nephrology, POCUS has been used randomly in patients hospitalized for acute renal failure to guide management.

Methods:

We prospectively evaluated 10 patients referred to our Onconephrology clinic for acute renal failure. POCUS was performed by a nephrologist trained to the technique with measurement of lying and standing blood pressure, heart rate, measurement of O2 saturation and clinical examination; The POCUS evaluation consisted of: 1. assessment of preload and systemic congestion (inferior vena cava diameter and collapsibility index, hepatic, portal and renal vein doppler), 2. Pump (heart) evaluation by assessing left ventricular systolic and diastolic heart function, end-diastolic filling pressures and right ventricular systolic function", 3. renal ultrasound in order to exclude obstructive nephropathy.

Results:

Patient’s hydration status was classified based on the clinical examination in euvolemia/dehydration/overload. POCUS evaluation gave a second look classification. For 5 out of 10 patients both evaluations gave the same conclusion, and a different diagnosis for 4 out of 10 patients. For 1 patient, the clinical evaluation did not allow a conclusion to be reached.

Conclusions:

In onconephrology, where patients often face complex, multifaceted issues involving both cancer and kidney disease such as acute kidney injury, POCUS offers a versatile, efficient, and patient-friendly tool that can significantly enhance care by enabling quick, accurate assessments and guiding timely interventions. Unlike traditional imaging techniques, POCUS allows for real-time, bedside assessment, enabling immediate clinical decisions, which is crucial in the often rapidly changing condition of cancer patients.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.