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Abstract: SA-PO141

Hepatic Duplex: Can the Liver Be of Service to the Kidney in Diagnosing AKI?

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Balina, Hema, Temple University, Philadelphia, Pennsylvania, United States
  • Noel, Edva, Temple University, Philadelphia, Pennsylvania, United States
  • Calvelli, Hannah, Temple University, Philadelphia, Pennsylvania, United States
  • Gibbons, Ryan C., Temple University, Philadelphia, Pennsylvania, United States
  • Costantino, Thomas, Temple University, Philadelphia, Pennsylvania, United States
  • Koratala, Abhilash, University of Wisconsin System, Madison, Wisconsin, United States
  • Gillespie, Avrum, Temple University, Philadelphia, Pennsylvania, United States
Background

Acute kidney injury (AKI) has a significant morbidity and mortality and better tools to diagnose the cause and inform the correct treatment are a research priority. We examined whether bedside venous duplex ultrasound of intra-abdominal organs differs in different causes of AKI.

Methods

A prospective single-center study of patients with cardiorenal, hepatorenal, acute tubular necrosis(ATN), and volume depletion acute kidney injury (AKI). Arrhythmias and body mass index (BMI)>30 were exclusions. Clinical data were obtained via chart review. Inferior vena cava diameter(IVC); hepatic vein and renal vein patterns; and Renal Resistive Indices(RRI) were obtained via Logic e BT-12 ultrasound. Sonographers were blinded from diagnoses. We used analysis of variance (ANOVA) for continuous variables and chi-square tests for categorical variables.

Results

We enrolled 81 AKI subjects, 34% with volume depletion, 19% cardiorenal, 35% ATN, 6% hepatorenal, and 3% other. Participants’ mean creatinine 2.74 (±1.47) mg/dL. The IVC diameters in ATN, volume depletion, hepatorenal, and cardiorenal were 2, 1.87, 1.95, and 2.34 cm respectively (p=0.17). Diminished or reversed systolic hepatic duplex was seen in only 2 patients with volume depletion(p=0.0001), and both these patients had moderate tricuspid regurgitation and elevated pulmonary arterial pressures on echocardiogram. Similar hepatic duplex findings were noted on day 2 and day 3. Portal vein was continuous in 62.1% ATN, 60.7% volume depletion, and 31.3% cardiorenal patients(p=0.74). Renal venous flow was continuous in 18.8% of the cardiorenal patients(p=0.67). RRI was not different in ATN(0.65±0.05), volume depletion(0.67±0.07), hepatorenal(0.69±0.09), and cardiorenal(0.67±0.08, p=0.25).

Conclusion

Hepatic vein, but not IVC, renal and portal venous flow, nor RRI can differentiate types of AKI. This non-invasive bedside tool can help diagnose AKI and future trials will examine management.