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Kidney Week

Abstract: SA-PO140

Discordance Between the Initial Etiological Diagnosis of AKI and that of the Nephrologist Based on a VExUS Study of Patients with AKI in an Acute Care Setting

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Noel, Edva, Temple University Hospital, Philadelphia, Pennsylvania, United States
  • Balina, Hema, Temple University Hospital, Philadelphia, Pennsylvania, United States
  • Calvelli, Hannah, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
  • Koratala, Abhilash, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
  • Gillespie, Avrum, Temple University Hospital, Philadelphia, Pennsylvania, United States
Background

Acute kidney injury (AKI) is associated with high morbidity and mortality. The correct diagnosis is essential for appropriate management because the treatments are very different between volume depletion, cardiorenal syndrome, hepatorenal syndrome, and acute tubular necrosis (ATN). We compare the initial diagnosis on presentation of AKI and the likely diagnosis based on the evaluation of a nephrologist based on a later chart review of the clinical course and diagnostic results.

Methods

In this single center, prospective, cohort study of ICU and ward patients who developed AKI during the admission we sought to determine the application of venous excess ultrasounds of intra-abdominal organs in discriminating the cause of AKI. We performed bedside US using a Logiq e BT12 machine, chart review and collection of baseline characteristics of all enrollees for 3 consecutive days. Baseline characteristics included: vital signs, 2D-echocardiogram, central venous pressure, right heart catheterization, urine electrolytes, urine protein-to-creatinine ratio, urine sediment. Ultra sonographers were blinded to the clinical diagnosis.

Results

We enrolled 80 patients with the initial diagnosis of AKI established by the primary care. Primary teams suspected ATN (23.5%), volume depletion (39.5%), hepatorenal (8.6%), cardiorenal (26%), and other causes (2.5%). The diagnoses posed by the primary care team were correct in 75% of the cases. ATN was mistakenly categorized as volume depletion 24% of the time and volume depletion as hepatorenal 29% of the time. Granular casts were present in 45% of ATN cases and 8% of non-ATN cases (p=0.0001), sensitivity 45%, specificity 92%. This includes 41% of misdiagnosed cases. As for VExUS, 70% of ATN cases were Grade 0, 64% of volume depletion, 50% of hepatorenal, and 33% of cardiorenal.

Conclusion

In a single-center prospective study of 80 patients with an initial diagnosis of AKI, the cause of AKI determined by the primary care team was discordant to that of the nephrology specialist in only 25% of the case. Urine sediment remains a useful tool in the diagnosis of AKI than VExUS. Future research is needed to examine the role of VExUS as a diagnostic tool.