Is Kidney Echogenicity an Early Indicator of AKI Recovery?
- Pediatric Nephrology - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
- Goswami, Shrea, Indiana University School of Medicine, Indianapolis, Indiana, United States
- Starr, Michelle C., Indiana University School of Medicine, Indianapolis, Indiana, United States
- Cater, Daniel, Indiana University School of Medicine, Indianapolis, Indiana, United States
- Schwaderer, Andrew L., Indiana University School of Medicine, Indianapolis, Indiana, United States
Kidney ultrasound echogenicity is a subjective finding reported by radiologists however it may be more clinically useful if quantified. We present a case report of a 15-year-old girl with acute kidney injury (AKI).
15-year-old girl was diagnosed with AML requiring treatment with a tyrosine kinase inhibitor, gilteritinib. Within two weeks of receipt of this agent she developed severe non-oliguric AKI, likely from medication induced thrombotic microangiopathy. Her baseline serum creatinine was 0.40 mg/dL with a peak of 6.83mg/dL, necessitating CKRT for 5 days. She was receiving serial abdominal ultrasounds for concerns for venous occlusive disease at the same time. Mean echogenicity (EI) was obtained by quantifying the grey scale pixel density of value of the right kidney cortex compared to the liver using adobe photoshop software.
Serial echogenicity index (mean EI) of the kidney cortex, weekly urine output (ml/kg/hour) and estimated glomerular filtration rate (eGFR) was collected during hospitalization. It appears that mean EI peaked on day 4 while eGFR was the lowest. Subsequently EI improved on day 7 while the eGFR had sustained improvement between days 21-42.
To our knowledge we are not aware of any reports studying kidney echogenicity as a marker for kidney recovery and raises the possibility that it may improve before other markers. EI as an early indicator of kidney recovery needs to be prospectively evaluated compared to other markers such as urine NGAL and, in oliguric patients, increasing urine output.
Clinical timeline of key parameters relevant to kidney recovery.