Ultrasound Helps Seek Cause of Acute Kidney Disease
POCUS devices — portable ultrasound machines or handheld probes that link to smartphones — help nephrologists discern the etiology of acute kidney injury (AKI). Also called acute kidney renal failure, AKI refers to the sudden loss of kidney function, typically due to a systemic illness, medications, or problem with another organ such as the heart or the liver.
“Up to 50% of patients admitted to the ICU have some degree of AKI,” said Abhilash Koratala, MD, nephrologist and MCW faculty member. “It could be precipitated by sepsis, or more commonly heart failure. A lesser proportion of AKI is caused by problems within the kidney itself, or urinary blockages where urine builds up in the urinary tract, can’t empty and backs up in the kidney.”
Bedside Ultrasounds Provide Faster Results
POCUS enables nephrologists to assess multiple organs quickly — the heart, lungs, kidneys and blood vessels in the abdomen — to determine the cause of AKI. It may also help patients avoid unnecessary radiation from CTs or other imaging.
“If clinicians are able to do ultrasound at the bedside, they can get answers to focused clinical questions within minutes without having to wait for the formal imaging report,” Dr. Koratala said. “It gives us a good idea of the overall hemodynamic status of the patient, and we can then act upon it.”
While POCUS may not replace a more detailed ultrasound performed by radiology or a comprehensive echocardiogram performed by the cardiology, the immediate data can guide critical decisions, such as whether to administer IV fluids or diuretics.
Ultrasound Technology for Efficient AKI Diagnosis
“We need answers to two or three focused questions, and POCUS fulfills that role, along with a physical exam, clinical judgment, lab work and patient history,” Dr. Koratala said. “Ultrasound is an established technology. What is new is the clinician performing the exam and interpreting it with immediate clinical correlation. POCUS is an enhancement to the conventional physical examination.”
“It has been shown that using point-of-care ultrasound can help us evaluate patients’ congestion better, detecting fluid accumulation even before the onset of symptoms; for example, lung ultrasound is better than chest X-ray in detecting pulmonary edema and is radiation-free,” Dr. Koratala said. “Following certain POCUS parameters helps us to objectively monitor the efficacy of the treatment we are giving. Knowing that, we hope to reduce the readmission rate of patients with heart failure by effectively addressing the residual congestion, which can be otherwise missed on the physical exam.”
POCUS is one the many technologies the Froedtert & MCW nephrology team uses to more efficiently diagnose and treat patients with kidney disease. Learn more about our diagnostic techniques, treatments and exceptional nephrology team providing kidney disease treatment.
To refer a patient to our nephrology team, call 414-805-7700 or visit our New Patient Appointment Request page. For a physician-to-physician phone consultation or patient transfer, call 414-805-4700.
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My concern regarding the use of POCUS is whether the health care provider performing the test will be held to the same diagnostic and reporting standards as a registered diagnostic medical sonographer, and be medicolegally liable as such.
We appreciate your feedback. Unlike comprehensive ultrasound studies that involve complete assessment of an anatomic region and documenting predefined parameters and measurements, POCUS is intended to answer focused clinical questions at the bedside. It is viewed as an upgrade to stethoscope and not a replacement for consultative imaging. The doctor performing POCUS is still required to document pertinent findings with supporting images.