![]() ![]() In addition, incidental renal lesions are frequently found, and the benefits of further evaluation and intervention for these incidental findings is unclear and could in some cases lead to harm. Reducing the number of unnecessary RUS reduces direct costs. In addition, the finding of hydronephrosis on ultrasound does not prove the presence of urinary tract obstruction since it is also seen in high urinary flow states such as with diuretic use, diabetes insipidus, pregnancy, previous obstruction, and congenital megaureter.ĭoppler ultrasonography with determination of resistive indices is an active area of research, with potential diagnostic and clinical implications, but determination of resistive indices on native renal ultrasound is not yet standard practice. Others have advocated a more restricted use of RUS given that the majority of cases of AKI in hospitalized patients are due to acute tubular necrosis or prerenal etiologies, and thus in most cases RUS results would not be expected to change management. ![]() Renal ultrasound (RUS) is often recommended in the evaluation of AKI to exclude the presence of hydronephrosis and urinary tract obstruction even when the pre-test probably for obstructive uropathy is low. Įvaluation to determine the cause of AKI includes review of the medical history and clinical course, routine blood biochemical measurements, and microscopic examination of the urine. The presence of AKI is associated with worse hospital outcome, and even a modest increase in creatinine significantly increases mortality. Otherwise, renal ultrasound is unlikely to yield useful results and should be used more selectively based on patients’ medical history.Īcute kidney injury (AKI) is common among hospitalized patients with a reported prevalence of 2 to 35%. Renal ultrasound for evaluation of acute kidney injury is indicated if there is medical history suggestive of urinary tract obstruction. Most other ultrasound findings were incidental and did not establish an etiology for the acute kidney injury. Less than 1% of patients (5 of 810) had urinary tract obstruction on ultrasound without a suggestive medical history. The majority of these patients (14 of 19) had a medical history suggestive of urinary tract obstruction. Hydronephrosis was detected in only 5% (42 of 810) of studies and in only 2.3% (19 of 810) of the cases was obstructive uropathy considered the cause of acute kidney injury. Renal ultrasound was normal in 62% (500 of 810) of patients. Over the 3-year period, 1471 renal ultrasounds were performed of which 55% (810) were for evaluation of acute kidney injury. The frequency of renal ultrasound abnormalities and clinical characteristics that predicted the finding of urinary tract obstruction was determined. Retrospective cohort study of all adult inpatients that underwent renal ultrasound for acute kidney injury over a 3-year period at a large university teaching hospital. Although renal ultrasound is often performed, its clinical utility in determining of the cause of acute kidney injury, particularly the detection of urinary tract obstruction, is not established. Acute kidney injury occurs commonly in hospitalized patients and is associated with significant morbidity and mortality. ![]()
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