Renal ultrasound provides low utility in evaluating cardiac surgery associated acute kidney injury
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RESEARCH ARTICLE
Open Access
Renal ultrasound provides low utility in evaluating cardiac surgery associated acute kidney injury Allen Young1*, Todd Crawford1, Alejandro Suarez Pierre1, J. Trent Magruder1, Charles Fraser1, John Conte1, Glenn Whitman1 and Christopher Sciortino2
Abstract Background: Renal ultrasonography is part of the algorithm in assessing acute kidney injury (AKI). The purpose of this study was to assess the clinical utility of renal US in postoperative cardiac patients who develop AKI. Methods: We conducted a retrospective study of 90 postoperative cardiac surgery patients at a single institution from 1/19/2010 to 3/19/2016 who underwent renal US for AKI. We reviewed provider documentation to determine whether renal US changed management. We defined change as: administration of crystalloid or colloid, addition of inotropic or vasopressor, or procedural interventions on the renal system. Results: Mean age of study patients was 68 ± 13 years. 48/90 patients (53.3%) had pre-existing chronic kidney disease of varying severity. 48 patients (53.3%) had normal renal US with incidental findings and 31 patients (34.4%) had US evidence of medical kidney disease. 10 patients (11.1%) had limited US results due to poor visualization and 1 patient (1.1%) had mild right-sided hydronephrosis. No patients were found to have obstructive uropathy or renal artery stenosis. Clinical management was altered in only 4/90 patients (4.4%), which included 3 patients that received a fluid bolus and 1 patient that received a fluid bolus and inotropes. No vascular or urologic procedures resulted from US findings. Conclusion: Although renal ultrasound is often utilized in the work-up of AKI, our study shows that renal US provides little benefit in managing postoperative cardiac patients. This diagnostic modality should be scrutinized rather than viewed as a universal measure in the cardiac surgery population. Keywords: Cardiac, Kidney, Renal function failure, Dialysis, Ultrasound, Postoperative care
Background Acute kidney injury (AKI) is a common complication in the Intensive Care Unit (ICU) setting and results in a substantial increase in hospital morbidity and mortality [1, 2]. Using the RIFLE criteria, the occurrence of AKI in the ICU setting has ranged from 22% to 36.1% [2, 3]. Renal ultrasound is often utilized in the setting of acute kidney injury to exclude obstructive nephropathy, which occurs in 5–25% of all patients and requires prompt intervention to salvage the kidney [4, 5]. In addition, conventional renal ultrasound can be enhanced by * Correspondence: [email protected] 1 Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Sheikh Zayed Tower 1800 Orleans Street, Baltimore, MD 21287, USA Full list of author information is available at the end of the article
Doppler to assess vasculature patency, renal perfusion, and to rule out renal artery stenosis [6, 7]. In cardiac surgery, the incidence of perioperative renal dysfunction with rising creatinine varies between 1 and 30% with 1% of
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