A Blueprint for an Integrated Point-of-Care Ultrasound Curriculum for Nephrology Trainees

Abstract

Point-of-care ultrasonography (POCUS) is a limited ultrasound study performed by the clinician at bedside as a component or an adjunct to physical examination. POCUS has multiple applications in nephrology practice including evaluation of obstructive uropathy, objective assessment of volume status, arteriovenous access assessment, and procedural guidance. However, unlike specialties such as emergency medicine, POCUS training is not yet integrated into most nephrology fellowship curricula, and the sonographic applications taught vary widely among fellowship programs. In this article, we have used our institutional experience to provide a roadmap or blueprint for nephrology programs looking to create a POCUS program. We provide an overview of the curriculum including the basic organization, applications taught, online resources, milestone development, and quality assessment. We also discuss the nuances of POCUS workflow and perspectives on billing for these limited studies. In addition, we share the evaluation forms and sample documentation we use in our program. Future support, in the form of endorsed nephrology society guidelines, are needed before POCUS training is universally incorporated across nephrology fellowship programs.

Demystifying hyponatremia: A clinical guide to evaluation and management

“…Similar observations have been replicated in various clinical settings associated with volume derangements, including heart failure, critical illness, and hemodialysis 41–43 . Over the past several years, POCUS has evolved as an enhancement to physical examination in various specialties, including nephrology and critical care 44,45 . It refers to clinician‐performed limited ultrasound examination intended to answer focused clinical questions.…”

“…[41][42][43] Over the past several years, POCUS has evolved as an enhancement to physical examination in various specialties, including nephrology and critical care. 44,45 It refers to clinician-performed limited ultrasound examination intended to answer focused clinical questions. Bedside sonographic evaluation of the pump (heart), pipes (inferior vena cava, abdominal venous Doppler), and the leaks (extravascular lung water, ascites) facilitates objective assessment of fluid status in conjunction with clinical and laboratory data.…”

Kidney Ultrasound for Nephrologists: A Review

“…There is a clear interest in this training because several US curricula have been outlined across the stages of medical training. 4,6,77,78 New technologies may also offer unforeseen opportunities. Chen et al 79 demonstrated the use of superresolution ultrasound imaging in the detection of alterations in the renal microvasculature in a murine model of acute kidney injury.…”

“…1,2 Several studies have argued for the formal incorporation of sonography into training and clinical practice, citing its increasing utility and accessibility in nephrology. [3][4][5][6][7] Taken together, advances in beamforming, image acquisition, and image processing make portable US a reality while lowering costs by several orders of magnitude. One of these advances is point-of-care US.…”

Nephrologist-Performed Point-of-Care Ultrasound in Acute Kidney Injury: Beyond Hydronephrosis

“…POCUS in nephrology is no longer confined to kidney ultrasound or procedural guidance but encompasses a wide range of applications, including lung ultrasound and limited echocardiography for fluid status assessment. 1 , 2 When evaluating a patient with acute kidney injury (AKI), it is important to systematically rule out the potential causes by careful history taking, physical examination, and analysis of laboratory data. POCUS is an adjunct to physical examination and aids in the diagnosis and management of AKI from excluding hydronephrosis to providing real-time insights into hemodynamic status.…”