ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO0266

Feasibility of Point-of-Care Solid Organ Doppler for Assessing Emergency Department Patients with AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Lindsay-McGinn, Forrest F., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Moore, Christy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Kramer, Jeffrey A., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Panebianco, Nova, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Teran, Felipe, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Reisinger, Nathaniel C., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
Background

Acute kidney injury (AKI) in the emergency department (ED) portends worse in-hospital outcomes for patients. Point-of-care ultrasound (POCUS) can assist with volume assessment, which is critical to diagnose the underlying cause of AKI. We describe clinical and ultrasonographic characteristics of patients with AKI using a POCUS protocol that examines hepatic, portal and interlobar renal vein spectral Doppler assessment previously described as the Venous Excess Ultrasound (VExUS) protocol which was found to predict AKI after cardiac surgery.

Methods

This is a prospective convenience sample of adult patients presenting to an academic, urban emergency department found to have AKI from September 2020 to May 2021. US images were obtained and interpreted by an US fellowship trained emergency medicine physician under the guidance of a certified vascular US technician. Spectral Doppler assessment of hepatic, portal, and interlobar renal veins were obtained. Hepatic vein dopplers were considered abnormal if the D wave was greater than the S wave. Portal vein Dopplers were considered abnormal if the pulsatility index was greater than 30%. Interlobar renal vein dopplers were considered abnormal if there was phasisity. The diagnosis of AKI was established by Kidney Disease Improving Global Outcomes criteria. The institutional review board approved this study.

Results

Thirty-seven patients were included. Median age was 63 and average BMI 29. 15 experienced stage 1 AKI, 5 had stage 2 AKI, 17 had stage 3 AKI. 7 required dialysis. 36 had an assessment of their inferior vena cava (IVC). 15 had an IVC >15mm with less than 50% respiratory collapse. Of the 15 patients with plethoric IVC assessments, 11 had interpretable hepatic vein Dopplers, 4 were abnormal. 14 had interpretable portal vein Dopplers, 6 were abnormal. 13 had interpretable interlobar renal vein Dopplers, 4 were abnormal. The most common reasons for uninterpretable Dopplers were difficulty holding expiration, arrhythmias and liver cirrhosis or masses.

Conclusion

Our study describes the feasibility of a POCUS assessment using solid organ spectral Doppler for emergency department patients with AKI. Further research is required to understand the test characteristics solid organ spectral Doppler for assessment of this population.