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Kidney Week

Abstract: SA-PO548

Focused Ultrasound in Nephrology: A Nephrology Fellow’s Perspective

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Saleem, Muhammad Omar, Medical College of Georgia, Augusta University, Augusta, Georgia, United States
  • Boyle, Colleen S., Medical College of Georgia, Augusta University, Augusta, Georgia, United States
  • Mohammed, Azeem, Medical College of Georgia, Augusta University, Augusta, Georgia, United States
  • White, John Jason, Medical College of Georgia, Augusta University, Augusta, Georgia, United States
  • Mulloy, Laura L., Medical College of Georgia, Augusta University, Augusta, Georgia, United States
  • Nahman, N. Stanley, Medical College of Georgia, Augusta University, Augusta, Georgia, United States

Group or Team Name

  • Nephrons@AU
Background

The portable bedside ultrasound has recently been widely used in clinical practice. The time efficient bedside evaluation is invaluable in managing a patient. Focused Assessment with Sonography for Trauma (FAST) exam is a standard now in Emergency Medicine. Renal fellows are also being encouraged by training programs to use this evolving tool to improve patient care. So we performed a series of case studies to assess usefulness of portable bedside sonography on acute renal consults, termed Focused Ultrasound in Nephrology (FUN)

Methods

14 patients were studied by a renal fellow and subjected to FUN. All patients had Acute Kidney Injury with an initial impression of pre, post or intra-renal etiology. Volume status was defined by physical exam. Bedside FUN was performed on the same day to see if it changed management. FUN is a quick 4 point bedside ultrasound on initial assessment of patients using a Philips Lumify portable ultrasound. 4 points chosen were bilateral lung scans at mid-axillary lines to look for lung B-lines, IVC for >50% collapsibility on inspiration and bladder scan for distension. Extra 2 point kidney ultrasound to look for kidney size and hydronephrosis was excluded because of lack of training.

Results

5 out of 14 patients’ management was changed on the basis of FUN: 6 scan findings validated the physical exam and 3 did not benefit from the study. 3 patients who were initially rendered euvolemic on physical exam, received IV diuretics when found to have significant lung B-lines (>3) with non-collapsing IVC by FUN. 2 patients who were initially rendered euvolemic had a change in diagnosis to pre-renal and received volume expansion when found more than 50% IVC collapsibility without significant lung B lines. In 3 cases bladder distension was picked up earlier at bedside and later confirmed by a sonogram performed by radiology.

Conclusion

We propose a 4-6 point FUN exam by fellows on acute renal consults. It is a real time assessment of intravascular volume status (pre-renal), pulmonary congestion, bladder obstruction (post-renal) and renal anatomy. Minor training is needed but potential benefits far outweigh the limitations of bedside FUN.