Introduction:
Acute kidney injury is a common and serious condition associated with high mortality, and timely radiological assessment is crucial for effective management. Waiting for a radiologist's opinion can delay the initiation of treatment. To address this, nephrologists are increasingly using point-of-care ultrasound (POCUS) for initial bedside evaluations, which allows for faster treatment decisions. The aim of this study is to use point-of-care ultrasound (POCUS) to examine kidney echogenicity, size, and bladder outlet, check volume status through IVC and lung ultrasound and compare the volume status clinically.
Methods:
In this prospective observational study, 50 AKI patients were included in our study. At admission, the patients' volume status was assessed clinically and they were divided into three groups, hypervolemic[Rise in BP, edema, basal crepitation on auscultation] hypovolemic[Reduced skin-tugor, postural hypotension] and euvolemic. Using POCUS, renal cortical echogenicity was evaluated, and obstructive pathology was ruled out. The volume status of the patients was further assessed by IVC measurement and USG of the lung [hypovolemic-collapsed ivc,hypervolemic-IVCdiameter(IVCD) >2cm/<50% collapsible,,kerley-B line in USG lung]. The correlation of patients volume status assessed both clinically and by POCUS was compared.
Results:
In our study on the use of point-of-care ultrasound (POCUS) in acute kidney injury (AKI), a total of 50 patients with AKI KDIGO Stage 3 were included. The mean age of the patients was 48.8 years, ranging from 20 to 78 years, with the majority being male (n=32, 64%).Key findings included increased renal echogenicity in 3 patients (6%), an increased resistive index in 6 patients (12%), and the diagnosis of obstructive nephropathy (bilateral hydroureteronephrosis) in 6 patients (12%) based on ultrasound findings. Additionally, 1 patient (2%) was diagnosed with pyelonephritis. Among the 26 patients (52%) who were clinically euvolemic, POCUS confirmed that 18 patients (36%) were euvolemic, 6 patients (12%) were hypervolemic, and 2 patients (4%) were hypovolemic. Out of 15 clinically hypervolemic patients (30%), 14 (28%) were confirmed to be hypervolemic, while 1 patient (2%) was found to be euvolemic by POCUS. Of the 9 clinically hypovolemic patients (18%), 5 (10%) were confirmed as hypovolemic, 3 (6%) were hypervolemic, and 1 (2%) was euvolemic by POCUS. In this study, 69.2% of patients who were euvolemic by POCUS were also clinically euvolemic, 93.3% of hypervolemic patients matched clinically, and 88.9% of hypovolemic patients were confirmed clinically (p < 0.0001).
Conclusions:
POCUS is a non-invasive, rapid, and reliable tool for assessing volume status in patients with AKI. Its strong correlation with clinical findings supports its use in guiding treatment decisions, such as dialysis and hydration therapy.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.