Renal Ultrasonography in the Evaluation of Acute Kidney Injury in the Emergency Department

Bennidor Raviv^1, and Shlomo Hanan Israelit¹

¹Department of Emergency Medicine, Rambam Medical Center, Haifa, Israel

Cite this paper

Bennidor Raviv and Shlomo Hanan Israelit. Renal Ultrasonography in the Evaluation of Acute Kidney Injury in the Emergency Department. American Journal of Clinical Medicine Research. 2014; 2(5):103-105. doi: 10.12691/AJCMR-2-5-3

Abstract

Background: Acute kidney injury is common in hospitalized patients, and is associated with high rates of morbidity and mortality. Only in a small part of cases it is secondary to obstructive etiologies. Ultrasonography of the urinary tract is todaya routine part of the evaluation of patients with acute kidney injury, and is debated regardingits value in the evaluation of all patients with acute kidney injury. Methods: A retrospective analysis of data of patients who presented to the emergency department of a tertiary medical center with acute kidney injury and who underwent ultrasound studies of the urinary tract. Aims: to evaluate the effectiveness of ultrasonography as a routine part in the evaluation of acute kidney injury in the emergent setting and to identify factors that may identify patients who will benefit of the study and patients who will not. Results: Substantial obstructive pathology was detected in more than 10% of the studies performed. The known history of nephrolithiasis and the use of anti-hypertensive medicines of the ARB/ACE groups and of diuretics were factors shown to have effect on the outcome of the studies performed. Conclusions: Ultrasonography is an important part of the routine evaluation of AKI in the emergency room. Use of certain medicines and history of urinary tract stonesare factors predictive of the findings on imaging studies.

Keywords

acute kidney injury, ultrasonography, Emergency department

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Walker SS, Liu KD, Chertow GM et al. Diagnosis, epidemiology and outcomes of acute kidney injury. Clin J Am Soc Nephrol. 2008; 3 (3): 844-861.
[2]	Liangos O, Wald R, O'Bell JW, Price L, Pereira BJ, Jaber BL. Epidemiology and outcomes of acute renal failure in hospitalized patients: a national survey. Clin J Am Soc Nephrol Jan. 2006; 14 (1): 43-51.
[3]	Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am SocNephrol Nov. 2005; 14 (11): 3365-3370.
[4]	Challiner R, Ritchie JP, Fullwood C, Loughnan P, Hutchinson AJ. Incidence and consequence of acute kidney injury in unselected emergency admissions to a large acute UK hospital trust. BMC Nephrol. 2014 May 29; 15: 84.
[5]	Licurse A, Kim MC, Dziura J, Forman HP, Formica RN, Makarov DV, Parikh CR, Gross CP. Renal ultrasonography in the evaluation of acute kidney injury: developing a risk stratification framework. Arch Intern Med. 2010 Nov 22; 170 (21): 1900-7.
[6]	Edelstein CSchrier R Pathophysiology of ischemic acute renal failure. Schrier RW Diseases of the kidney and urinary tract. 7th ed. Philadelphia, PA Lippincott Williams and Wilkins 2001:1041-1070.
[7]	Bellomo R, Kellum JA, Ronco C. Acute kidney injury. Lancet. 2012; 14 (9843): 756-766.
[8]	Podoll A, Walther C, Finkel K. Clinical utility of gray scale renal ultrasound in acute kidney injury. BMC Nephrol. 2013 Sep 8; 14: 188.
[9]	Gottlieb RH, Weinberg EP, Rubens DJ, Monk RD, Grossman EB. Renal sonography: can it be used more selectively in the setting of an elevated serum Creatinine level? Am J Kidney Dis Mar. 1997; 14 (3): 362-367.
[10]	Ritchie WW, Vick CW, Glocheski SK, Cook DE. Evaluation of azotemic patients: diagnostic yield of initial US examination. Radiology Apr. 1988; 14 (1): 245-247.
[11]	Le Dorze M, Bougle A, Deruddre S, Duranteau J. Renal Doppler ultrasound: a new tool to assess renal perfusion in critical illness. Shock Apr. 2012; 14 (4):360-365.
[12]	Bentley ML, Corwin HL, Dasta J. Drug-induced acute kidney injury in the critically ill adult: recognition and prevention strategies. Crit Care Med. 2010; 38 (6 Suppl): S169-S174.
[13]	Pannu N, Nadim MK. An overview of drug-induced acute kidney injury. Crit Care Med. 2008; 36 (4 Suppl): S216-S223.
[14]	Cecil RL, Goldman L, Ausiello DA. Cecil Medicine. Philadelphia, PA: Saunders Elsevier; 2008
[15]	Brisco MA, Coca SG, Chen J, Owens AT, McCauley BD, Kimmel SE, Testani JM. Blood urea nitrogen/ Creatinine ratio identifies a high risk but potentially reversible form of renal dysfunction in patients with decompensated heart failure. Circ heart Fail. 2013 Mar; 6 (2): 233-9. 2013 Jan 16.