Issues: Vol 07 Kidney Issue - FEB 2022

POCUS Journal Volume 07 Special Kidney Issue, released Feb 2022

About the Special Kidney Issue

Nathaniel Reisinger, MD; Abhilash Koratala, MD – We know what you’re thinking. we’ve heard it a thousand times: “Oh, you’re a kidney doctor who dinks around with ultrasound? What do you look for? Hydronephrosis?” You may be asking, “Is this issue just going to be a bunch of pictures of hydronephrosis and distended bladders?” And yes, for the thousandth time, in acute kidney injury it’s almost never wrong to get a kidney and bladder ultrasound as part of the initial workup.

Integrating Point of Care Ultrasound into Nephrology Fellowship Training: Insights from a Pilot Program

Ann Young, MD PhD; Benoit Imbeault, MD; Alberto Goffi, MD; Alireza Zahirieh, MD; Claire Kennedy, MD; Daniel Blum, MDCM; Ron Wald, MDCM MPH; William Beaubien-Souligny, MD PhD – In nephrology, point of care ultrasound (POCUS) has multiple applications including the rapid evaluation of acute kidney injury, enhancing the initial evaluation of chronic kidney disease, direct evaluation of vascular access, and improved fluid balance management in acute and chronic settings. Recently, the role of POCUS has been formally acknowledged by the American College of Physicians and curricula specific to nephrology have been proposed.

Nephrology Fellowship Clinician-Performed Ultrasound Curriculum

Nathaniel Reisinger, MD; Nova Panebianco, MD, MPH – Fluid overload (FO) contributes significantly to the development of cardiovascular disease among patients with end-stage kidney disease (ESKD) on hemodialysis (HD), yet remains underappreciated due to limitations of the physical exam. Lung ultrasound (US) is an established tool for quantification of FO.

Point of Care Ultrasound Diagnosis of Pseudoaneurysm of an Upper Extremity Arteriovenous Dialysis Graft

Forrest Lindsay-McGinn, MD; Nathaniel C. Reisinger, MD – We describe the rapid diagnosis with point of care ultrasound (POCUS) of two acute pseudoaneurysms of a bovine arteriovenous dialysis graft with superimposed cellulitis in a 44-year old male patient who presented with pain over his upper arm graft site. POCUS evaluation decreased the time to diagnosis and vascular surgery consultation.

Utility of Nephrologist-Performed Point of Care Ultrasonography in the Evaluation of Hyponatremia

Mahmud Saqib, MD; Gregory Capelli, DO; Abhilash Koratala, MD – Point of care ultrasonography can be a valuable adjunct to conventional physical examination in patients with hyponatremia that aids in clinical decision making. It can address the shortcomings of traditional volume status assessment such as the inherent low sensitivity of ‘classic’ signs such as lower extremity edema.

Point of Care Ultrasonography to Monitor Decongestive Therapy in Heart Failure: Seeing is Believing

Abhilash Koratala, MD – Point of care ultrasonography (POCUS) is a non-invasive bedside diagnostic tool that aids in clinical decision-making process. In addition, it allows to monitor the efficacy of therapeutic interventions in real time. As such, nephrologists can enhance patient care by adopting this skill, especially in those with simultaneous cardiac dysfunction and difficult to manage fluid status.

Evaluation of Venous Congestion Using Beside Ultrasonography by the Nephrology Consultant: The VExUS Nexus

Abhilash Koratala, MD – In patients with heart failure and cardiorenal syndrome, lingering congestion is associated with worse outcomes. As such, titrating diuretic or ultrafiltration therapy based on objective assessment of volume status plays a crucial role in the management of these patients. Conventional physical examination findings and parameters such as daily weight measurement are not always reliable in this setting. Recently, point of care ultrasonography (POCUS) has emerged as an attractive enhancement to bedside clinical examination in assessing fluid volume status.

Recovery of Severe Acute Kidney Injury in a Patient with COVID-19: Role of Lung Ultrasonography

Varun Madireddy, MD; Daniel W. Ross, MD MPH; Deepa A. Malieckal, MD; Shamir Hasan, DO;  Azzour Hazzan, MD;  Hitesh H. Shah, MD – Acute kidney injury (AKI) is recognized as a complication of COVID-19 among hospitalized patients. Lung ultrasonography (LUS) can be a useful tool in the management of COVID-19 pneumonia when interpreted correctly. However, the role of LUS in management of severe AKI in the setting of COVID-19 remains to be defined.