PoCUS in nephrology: a new tool to improve our diagnostic skills

Abstract

Point-of-Care Ultrasonography (PoCUS) aims to include a fifth pillar (insonation) in the classical physical examination in order to obtain images to answer specific questions by the clinician at the patient's bedside, PoCUS allowing rapid identification of structural or functional abnormalities, enabling more accurate volume assessment, supporting diagnosis, as well as guiding procedures. In recent years, PoCUS is becoming a valuable tool in day-to-day clinical practice, adopted by health care professionals from various medical specialties, never replacing physical examination but improving patient and medical care and experience. Renal patients represent a wide range of diseases, which gives PoCUS a special role to work with as a valuable tool in different scenarios, not only for volume-related information but also for the assessment of a wide range of acute and chronic conditions, enhancing the sensitivity of conventional physical examination in nephrology. PoCUS in the hands of a nephrologist is a precision medicine tool.

Effect on Kidney Function Recovery Guiding Decongestion with VExUS in Patients with Cardiorenal Syndrome 1: A Randomized Control Trial

“…Although intravascular congestion is a variable associated with mortality in CRS1 and promoting its decongestion is a relevant goal, it may be that VExUS only identifies the venous congestion phenotype, and it does not identify the interstitial congestion phenotype, which is also important. Thus, VExUS does not fully integrate the phenotype congestion as a whole, leaving certain patients with no venous congestion (theoretically VExUS grade 0) but with interstitial and lung residual congestion [14,17,41] without effective treatments. It is important to note that the VExUS score at bedside is performed quickly, takes less than 5 min, is non-invasive, and does not cause pain.…”

Acute kidney injury and point-of-care ultrasound in liver cirrhosis: redefining hepatorenal syndrome

“…In addition, the recently described VExUS protocol allows for the identification and stratification of systemic venous congestion by complementing IVC assessment with pulsed Doppler of the suprahepatic veins, portal vein and interlobar renal veins to assess for altered flow patterns observed in venous congestion. Prior reviews summarized the pathophysiological basis of this ultrasound protocol, the findings in the pulsed Doppler scan, its correct interpretation and pitfalls [ 23–26 ].…”

Practical approaches to building up a cardiorenal clinic

“…urgent requirement for KRT, elderly and frail patients with barriers to self-care, anatomic contraindication to PD, healthcare structure, financing and delivery), and the cardiorenal team may provide supportive care to achieve patient-centred goals. For instance, an integrative and comprehensive assessment of the cardiac function and volume status combining ultrasound techniques, bioimpedance tools and biomarkers (dry weight revisited) may guide the need and the rate of fluid removal, enhancing haemodynamic tolerance [ 30–32 ]. Furthermore, HHD is emerging as an attractive modality that may overcome the adverse consequences of interdialytic cycles of hypervolemia coupled with rapid and aggressive ultrafiltration commonly seen with conventional HD [ 29 ].…”