Back to Bedside: Kidney Point-of-Care Ultrasonography (POCUS) by Resident Physicians for Identification of Hydronephrosis in Patients with AKI

Document Type

Abstract

Publication Date

Fall 10-2024

Abstract

Background: POCUS has emerged as a valuable adjunct to bedside clinical examinations. In context of acute kidney injury (AKI), bedside POCUS may facilitate early identification of hydronephrosis indicative of obstructive uropathy as the underlying etiology, thereby enabling timely diagnosis, expediting therapeutic management and decreasing fragmentation of care. Incorporating renal POCUS training in the internal medicine residency program allows residents to develop new skills for day-to-day clinical practice and enhance bedside assessment of patients with AKI. Methods: We conducted a prospective observational study at Hamad General Hospital, Qatar. Patients were selected from a convenience sample in the Acute Medical Assessment Unit (AMAU) and medical wards for AKI evaluation. Internal Medicine residents underwent mandatory training, including a 30-minute didactic session by a certified physician and performing ten supervised bilateral renal POCUS scans to ensure proper technique. Residents performed bedside renal POCUS to assess hydronephrosis, with findings compared to blinded departmental scans using a common grading system. Results: Fifty patients with provisional AKI diagnoses based on clinical presentation and renal parameters were included, all pending official renal ultrasound scans. Bedside POCUS identified hydronephrosis in nine patients (one bilateral, eight unilateral). Of these, five were confirmed by departmental ultrasound, and one additional patient with hydronephrosis was missed by POCUS but identified on the formal scan. Conclusions: This project demonstrated that using POCUS for diagnosing and managing AKI to identify hydronephrosis had a sensitivity of 83.3%, specificity of 93%, positive predictive value of 55.6%, and negative predictive value of 98%. The strength of our study is utilization of senior clinical physicians for POCUS training to guide junior residents in enhancing their skills and bedside assessment of patients with AKI. POCUS-enhanced bedside exams allow residents to identify hydronephrosis in a sensitive and time-efficient manner, facilitating timely diagnosis of obstructive uropathy and appropriate patient management.

Publication Title

Journal of the American Society of Nephrology

Volume

35

Issue

10S

First Page

497

Last Page

497

Comments

Kidney Week, San Diego, CA held October 24-27, 2024.

Link to Full Text

Open Access

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