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      Point of care renal ultrasonography for the busy nephrologist: A pictorial review

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          Abstract

          The application of bedside ultrasonography in routine clinical practice has dramatically evolved over the last few decades and will likely continue to grow as technological advances lead to enhanced portability and affordability of the equipment. Despite mounting interest, most nephrology fellowship training programs do not offer formal training in renal ultrasonography and there is inertia among practicing nephrologists to adopt this skill as a practice-changing advancement. Lack of familiarity with the topic is considered a key reason for this inertia. Understanding of basic ultrasound physics, instrumentation, principles of optimal image acquisition and interpretation is critical for enhanced efficiency and patient safety while using this tool. Herein, we provide a brief overview of the basic principles of diagnostic renal ultrasonography as well as introduction to common sonographic pathologies encountered in day-to-day nephrology practice with illustrative images.

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          Detection of pulmonary congestion by chest ultrasound in dialysis patients.

          Francesca Mallamaci, Francesco A Benedetto, Rocco Tripepi … (2010)
          This study sought to investigate clinical and echocardiographic correlates of the lung comets score. Early detection of pulmonary congestion is a fundamental goal for the prevention of congestive heart failure in high-risk patients. We undertook an inclusive survey by a validated ultrasound (US) technique in a hemodialysis center to estimate the prevalence of pulmonary congestion and its reversibility after dialysis in a population of 75 hemodialysis patients. Chest US examinations were successfully completed in all patients (N = 75). Before dialysis, 47 patients (63%) exhibited moderate to severe lung congestion. This alteration was commonly observed in patients with heart failure but also in the majority of asymptomatic (32 of 56, 57%) and normohydrated (19 of 38, 50%) patients. Lung water excess was unrelated with hydration status but it was strongly associated with New York Heart Association functional class (p < 0.0001), left ventricular ejection fraction (r = -0.55, p < 0.001), early filling to early diastolic mitral annular velocity (r = 0.48, p < 0.001), left atrial volume (r = 0.39, p = 0.001), and pulmonary pressure (r = 0.36, p = 0.002). Lung water reduced after dialysis, but 23 patients (31%) still had pulmonary congestion of moderate to severe degree. Lung water after dialysis maintained a strong association with left ventricular ejection fraction (r = -0.59, p < 0.001), left atrial volume (r = 0.30, p = 0.01), and pulmonary pressure (r = 0.32, p = 0.006) denoting the critical role of cardiac performance in the control of this water compartment in end-stage renal disease. In a multiple regression model including traditional and nontraditional risk factors only left ventricular ejection fraction maintained an independent link with lung water excess (beta = -0.61, p < 0.001). Repeatability studies of the chest US technique (Bland-Altman plots) showed good interobserver and inter-US probes reproducibility. Pulmonary congestion is highly prevalent in symptomatic (New York Heart Association functional class III to IV) and asymptomatic dialysis patients. Chest ultrasound is a reliable technique that detects pulmonary congestion at a pre-clinical stage in end-stage renal disease. Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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            Pyelonephritis: radiologic-pathologic review.

            William D Craig, Brent Wagner, Mark Travis (2015)
            Urinary tract infections are the most common urologic disease in the United States and annually account for over 7 million office and 1 million emergency department visits. In adults, diagnosis of urinary tract infection is typically based on characteristic clinical features and abnormal laboratory values. Imaging is usually reserved for patients who do not respond to therapy and for those whose clinical presentation is either atypical or potentially life threatening. Urinary tract infection typically originates in the urinary bladder; when it migrates to the kidney or is seeded there hematogenously, a tubulointerstitial inflammatory reaction ensues, involving the renal pelvis and parenchyma. The condition is characterized as pyelonephritis. Complicated and uncomplicated pyelonephritis, xanthogranulomatous pyelonephritis, and tuberculosis are all urinary tract infections for which imaging evaluation adds diagnostic information important for patient care. Computed tomography (CT), when performed before, immediately after, and at delayed intervals from contrast material injection, is the preferred modality for evaluating acute bacterial pyelonephritis. CT is also preferred over conventional radiography and ultrasonography (US) for assessing emphysematous pyelonephritis. Xanthogranulomatous pyelonephritis is a chronic granulomatous process, induced by recurrent bacterial urinary tract infection. Although US is useful in the diagnosis of this condition, CT is the main imaging tool, as it provides highly specific findings and accurate assessment of the extrarenal extent of disease, which is essential for surgical planning. The increasing prevalence of tuberculosis and continued emergence of antibiotic-resistant strains have significance for genitourinary radiologists, as the urinary tract is the most common extrapulmonary site of tuberculosis. Familiarity with the renal manifestations of the disease--pelvoinfundibular strictures, papillary necrosis, cortical low-attenuation masses, scarring, and calcification--will help in the diagnosis, even in the absence of documented pulmonary disease.
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              Intrarenal resistive index after renal transplantation.

              Maarten Naesens, Line Heylen, Evelyne Lerut … (2013)
              The intrarenal resistive index is routinely measured in many renal-transplantation centers for assessment of renal-allograft status, although the value of the resistive index remains unclear.
              Article 0 comments Cited 55 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Abhilash Koratala
                Deepti Bhattacharya
                Amir Kazory
                Journal
                Journal ID (nlm-ta): World J Nephrol
                Journal ID (publisher-id): WJN
                Title: World Journal of Nephrology
                Publisher: Baishideng Publishing Group Inc
                ISSN (Electronic): 2220-6124
                Publication date (Print): 28 June 2019
                Publication date (Electronic): 28 June 2019
                Volume: 8
                Issue: 3
                Pages: 44-58
                Affiliations
                Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, FL 32610-0224, United States. akoratsla@ 123456ufl.edu
                Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, FL 32610-0224, United States
                Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, FL 32610-0224, United States
                Author notes

                Author contributions: Koratala A performed majority of the writing, prepared the images; Bhattacharya D performed literature review and assisted in writing; Kazory A reviewed and revised the manuscript for critical intellectual content.

                Corresponding author: Abhilash Koratala, MD, Assistant Professor, Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, P.O. Box 100224, Gainesville, FL 32610-0224, United States. akoratsla@ 123456ufl.edu

                Telephone: +1-352-27353 Fax: +1-352-3923581

                Article
                Other ID: jWJN.v8.i3.pg44
                DOI: 10.5527/wjn.v8.i3.44
                PMC ID: 6656660
                PubMed ID: 31363461
                SO-VID: ec50342b-aeac-401f-a526-7700b3562594
                Copyright © ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
                License:

                This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                Date received : 10 January 2019
                Date revision received : 22 February 2019
                Date accepted : 12 March 2019
                Categories
                Subject: Minireviews

                Keywords: ultrasound,kidney,cyst,hydronephrosis,stone,point of care
                Data availability:
                Keywords: ultrasound, kidney, cyst, hydronephrosis, stone, point of care

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