Clinical utility of gray scale renal ultrasound in acute kidney injury

BMC Nephrology

Kevin Finkel¹  Carl Walther¹  Amber Podoll¹ 

[1] UTHealth Science Center at Houston, Department of Internal Medicine, Division of Renal Diseases & Hypertension, 6431 Fannin MSB 5.134, Houston, TX 77030, USA

关键词: Ultrasound;    Urinary tract obstruction;    Hydronephrosis;    Acute kidney injury;   

Others  :  1082851
DOI  :  10.1186/1471-2369-14-188

 received in 2013-05-15, accepted in 2013-09-04,  发布年份 2013

【 摘 要 】

Background

Acute kidney injury occurs commonly in hospitalized patients and is associated with significant morbidity and mortality. Although renal ultrasound is often performed, its clinical utility in determining of the cause of acute kidney injury, particularly the detection of urinary tract obstruction, is not established.

Methods

Retrospective cohort study of all adult inpatients that underwent renal ultrasound for acute kidney injury over a 3-year period at a large university teaching hospital. The frequency of renal ultrasound abnormalities and clinical characteristics that predicted the finding of urinary tract obstruction was determined.

Results

Over the 3-year period, 1471 renal ultrasounds were performed of which 55% (810) were for evaluation of acute kidney injury. Renal ultrasound was normal in 62% (500 of 810) of patients. Hydronephrosis was detected in only 5% (42 of 810) of studies and in only 2.3% (19 of 810) of the cases was obstructive uropathy considered the cause of acute kidney injury. The majority of these patients (14 of 19) had a medical history suggestive of urinary tract obstruction. Less than 1% of patients (5 of 810) had urinary tract obstruction on ultrasound without a suggestive medical history. Most other ultrasound findings were incidental and did not establish an etiology for the acute kidney injury.

Conclusions

Renal ultrasound for evaluation of acute kidney injury is indicated if there is medical history suggestive of urinary tract obstruction. Otherwise, renal ultrasound is unlikely to yield useful results and should be used more selectively based on patients’ medical history.

【 授权许可】

   
2013 Podoll et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Hou SH, Bushinsky DA, Wish JB, Cohen JJ, Harrington JT: Hospital-acquired renal insufficiency: a prospective study. Am J Med Feb 1983, 74(2):243-248.
• [2]Liangos O, Wald R, O'Bell JW, Price L, Pereira BJ, Jaber BL: Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. Clin J Am Soc Nephrol Jan 2006, 1(1):43-51.
• [3]Nash K, Hafeez A, Hou S: Hospital-acquired renal insufficiency. Am J Kidney Dis May 2002, 39(5):930-936.
• [4]Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW: Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol Nov 2005, 16(11):3365-3370.
• [5]Bellomo R, Kellum JA, Ronco C: Acute kidney injury. Lancet 2012, 380(9843):756-766.
• [6]Singri N, Ahya SN, Levin ML: Acute renal failure. JAMA 2003, 289(6):747-751.
• [7]Gottlieb RH, Weinberg EP, Rubens DJ, Monk RD, Grossman EB: Renal sonography: can it be used more selectively in the setting of an elevated serum creatinine level? Am J Kidney Dis Mar 1997, 29(3):362-367.
• [8]Licurse A, Kim MC, Dziura J, Forman H, Formica R, Makarov D, Parikh C, Gross C: Renal ultrasonography in the evaluation of acute kidney injury: developing a risk stratification framework. Arch Intern Med Nov 2010, 170(21):1900-1907.
• [9]Ritchie WW, Vick CW, Glocheski SK, Cook DE: Evaluation of azotemic patients: diagnostic yield of initial US examination. Radiology Apr 1988, 167(1):245-247.
• [10]Liano F, Junco E, Pascual J, Madero R, Verde E: The spectrum of acute renal failure in the intensive care unit compared with that seen in other settings. the Madrid acute renal failure study group. Kidney Int Suppl 1998, 66:S16-S24.
• [11]Schnell D, Darmon M: Renal Doppler to assess renal perfusion in the critically ill: a reappraisal. Intensive care med Nov 2012, 38(11):1751-1760.
• [12]Le Dorze M, Bougle A, Deruddre S, Duranteau J: Renal Doppler ultrasound: a new tool to assess renal perfusion in critical illness. Shock Apr 2012, 37(4):360-365.
• [13]Bradley AJ, Lim YY, Singh FM: Imaging features, follow-up, and management of incidentally detected renal lesions. Clin Radiol 2011, 66(12):1129-1139.
• [14]Hollingsworth JM, Miller DC, Daignault S, Hollenbeck BK: Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst 2006, 98(18):1331-1334.
• [15]Amis ES Jr, Cronan JJ, Pfister RC, Yoder IC: Ultrasonic inaccuracies in diagnosing renal obstruction. Urology 1982, 19(1):101-105.
• [16]Liu KD, Chertow GM: Curbing the use of ultrasonography in the diagnosis of acute kidney injury: Penny wise or pound foolish?: comment on "renal ultrasonography in the evaluation of acute kidney injury. Arch Intern Med 2010, 170(21):1907-1908.
• [17]Keyserling HF, Fielding JR, Mittelstaedt CA: Renal sonography in the intensive care unit: when is it necessary? J Ultrasound Med Off J Am Inst Ultrasound Med May 2002, 21(5):517-520.