POCUS for Nephrologists: Basic Principles and a General Approach

Abstract

Point of care ultrasonography (POCUS) has evolved as a valuable adjunct to physical examination in the recent past and various medical specialties have embraced it. However, POCUS training and scope of practice remain relatively undefined in nephrology. The utility of diagnostic POCUS beyond kidney and vascular access is under-recognized. Assessment of fluid status is a frequent dilemma faced by nephrologists in day-to-day practice where multi-organ POCUS can enhance the sensitivity of conventional physical examination. POCUS also reduces fragmentation of care, facilitates timely diagnosis, and expedites management. While the need for further imaging studies is obviated in selected cases, POCUS is not meant to serve as an alternative to consultative imaging. In addition, utility of POCUS depends on the skills and experience of the operator, which in turn depends on the quality of training. In this review, we discuss the rationale behind nephrologists performing POCUS, discuss case examples to illustrate the basic principles of focused ultrasonography, and share our experience-based opinion about developing a POCUS training program at the institutional level.

Diagnosis of Fluid Overload: From Conventional to Contemporary Concepts

“…Point-of-care ultrasonography (POCUS) is a limited bedside ultrasound examination performed by the clinician to answer focused questions to confirm a diagnosis or narrow the differential or guide a procedure. Over the past several years, multi-organ POCUS has evolved as an adjunct to physical examination in specialties such as emergency medicine, critical care, and nephrology [74,75]. We previously proposed the pump-pipes-leaks approach to conduct a goal-directed POCUS-assisted hemodynamic evaluation in patients with HF and FO [76].…”

Consenso de posgrados de nefrología de Colombia: implantación de catéteres de hemodiálisis bajo guía ecográfica

“…En nefrología la ecografía es una herramienta de uso diario que ofrece un campo apasionante y con un notable crecimiento en diferentes aspectos del desempeño de la especialidad; útil en pacientes con patología renal aguda y crónica. Su utilidad no se limita a la colocación de catéteres vasculares, sino también en el estudio ecográfico del riñón, la evaluación y seguimiento de fístulas arteriovenosas, la evaluación volumétrica con VEXUS y POCUS, realización de biopsias renales e implante de catéteres peritoneales, entre otros procedimientos que son competencias que se desarrollan durante el entrenamiento en nefrología 36,37 .…”

“…El escenario de uso para los nefrólogos incluye la atención del paciente intrahospitalario o en cuidado crítico no solo para la inserción de catéter, sino para su diagnóstico y tratamiento al lado de la cama; es posible, de manera sistemática, rápida y certera descartar patologías urinarias obstructivas (volumen vesical, hidronefrosis, litiasis), evaluar la volemia objetivamente en la lesión renal aguda prerrenal o determinar cambios congestivos que pueden cambiar conductas terapéuticas de manera tangencial al seguir los lineamientos de VEXUS o de POCUS, de fácil implementación e interpretación y que en recientes años ha mostrado su factibilidad y costo efectividad 36,38 .…”

Venous Excess Doppler Ultrasound for the Nephrologist: Pearls and Pitfalls

“…Careful history taking, physical examination, vital signs, and interpretation of laboratory data aid in this process but have several limitations. 1 , 2 , 3 In addition, the traditional approach to hypotension and/or abnormal kidney function has been forward flow–centric, with an emphasis on increasing cardiac output and, thereby, kidney blood flow. Therefore, intravenous fluids are often administered empirically in such cases.…”