Kidney Week

Abstract: FR-PO115

Back to Bedside: Kidney Point-of-Care Ultrasonography (POCUS) by Resident Physicians for Identification of Hydronephrosis in Patients with AKI

Session Information

• AKI: Diagnosis and Outcomes
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Sardar, Sundus, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States

Sundus Sardar, MD

• Sharma, Rohit, Department of Internal Medicine, Geisinger Health System, Wilkes-Barre, Pennsylvania, United States

Rohit Sharma, MD

• Mohammad Arshad, Abdullah, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar

Abdullah Mohammad Arshad, MBBS

• Alamin, Mohammed, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar

Mohammed Alamin, MD

• Tanous, Bashar, Department of Internal Medicine, UCSF Fresno, San Francisco, California, United States

Bashar Tanous, MBChB

• Akram, Jaweria, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar

Jaweria Akram, MBBS

• Ata, Fateen, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar

Fateen Ata, MD, MSc

• Jebril, Rawand, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar

Rawand Jebril, MD

• Al-Mashdali, Abdulrahman, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar

Abdulrahman Al-Mashdali, MD

• Yousaf, Zohaib, Tower Health, West Reading, Pennsylvania, United States

Zohaib Yousaf, MD, MSc

• Zahid, Muhammad, Hamad Medical Corporation, Doha, Ad Dawhah, Qatar

Muhammad Zahid, MBBS

Background

POCUS has emerged as a valuable adjunct to bedside clinical examinations. In context of acute kidney injury (AKI), bedside POCUS may facilitate early identification of hydronephrosis indicative of obstructive uropathy as the underlying etiology, thereby enabling timely diagnosis, expediting therapeutic management and decreasing fragmentation of care. Incorporating renal POCUS training in the internal medicine residency program allows residents to develop new skills for day-to-day clinical practice and enhance bedside assessment of patients with AKI.

Methods

We conducted a prospective observational study at Hamad General Hospital, Qatar. Patients were selected from a convenience sample in the Acute Medical Assessment Unit (AMAU) and medical wards for AKI evaluation. Internal Medicine residents underwent mandatory training, including a 30-minute didactic session by a certified physician and performing ten supervised bilateral renal POCUS scans to ensure proper technique. Residents performed bedside renal POCUS to assess hydronephrosis, with findings compared to blinded departmental scans using a common grading system.

Results

Fifty patients with provisional AKI diagnoses based on clinical presentation and renal parameters were included, all pending official renal ultrasound scans. Bedside POCUS identified hydronephrosis in nine patients (one bilateral, eight unilateral). Of these, five were confirmed by departmental ultrasound, and one additional patient with hydronephrosis was missed by POCUS but identified on the formal scan.

Conclusion

This project demonstrated that using POCUS for diagnosing and managing AKI to identify hydronephrosis had a sensitivity of 83.3%, specificity of 93%, positive predictive value of 55.6%, and negative predictive value of 98%. The strength of our study is utilization of senior clinical physicians for POCUS training to guide junior residents in enhancing their skills and bedside assessment of patients with AKI. POCUS-enhanced bedside exams allow residents to identify hydronephrosis in a sensitive and time-efficient manner, facilitating timely diagnosis of obstructive uropathy and appropriate patient management.