Licurse Adam, Kim Michael C, Dziura James, Forman Howard P, Formica Richard N, Makarov Danil V, Parikh Chirag R, Gross Cary P
Yale University, New Haven, CT 06520-8025, USA.
Arch Intern Med. 2010 Nov 22;170(21):1900-7. doi: 10.1001/archinternmed.2010.419.
In adult inpatients with acute kidney injury (AKI), clinicians routinely order a renal ultrasonography (RUS) study. It is unclear how often this test provides clinically useful information.
Cross-sectional study, including derivation and validation samples, of 997 US adults admitted to Yale-New Haven Hospital from January 2005 to May 2009, who were diagnosed as having AKI and who underwent RUS to evaluate elevated creatinine level. Pregnant women, renal transplant recipients, and patients with recently diagnosed hydronephrosis (HN) were excluded. Demographic and clinical characteristics were abstracted from the medical records. A multivariable logistic regression model was developed to create risk strata for HN and HN requiring an intervention (HNRI); a separate sample was used for validation. The frequency of incidental findings on RUS was assessed for each stratum.
In a derivation sample of 200 patients, 7 factors were found to be associated with HN: history of HN; recurrent urinary tract infections; diagnosis consistent with obstruction; nonblack race; and absence of the following: exposure to nephrotoxic medications, congestive heart failure, or prerenal AKI. Among 797 patients in the validation sample (mean age, 65.6 years), 10.6% had HN and 3.3% had HNRI. Of 223 patients in the low-risk group, 7 (3.1%) had HN and 1 (0.4%) had HNRI (223 patients needed to be screened to find 1 case of HNRI). In this group, there were 0 incidental findings on RUS unknown to the clinical team. In the higher-risk group, 15.7% had HN and 4.7% had HNRI.
In adult inpatients with AKI, specific factors can identify patients unlikely to have HN or HNRI on RUS.
在成年急性肾损伤（AKI）住院患者中，临床医生通常会安排肾脏超声（RUS）检查。目前尚不清楚该检查能提供临床有用信息的频率。
对2005年1月至2009年5月入住耶鲁-纽黑文医院的997名美国成年患者进行横断面研究，这些患者被诊断为AKI并接受了RUS检查以评估肌酐水平升高情况。排除孕妇、肾移植受者和近期诊断为肾盂积水（HN）的患者。从病历中提取人口统计学和临床特征。建立多变量逻辑回归模型以创建HN和需要干预的HN（HNRI）的风险分层；使用单独的样本进行验证。评估每个分层中RUS偶然发现的频率。
在200例患者的推导样本中，发现7个因素与HN相关：HN病史；复发性尿路感染；与梗阻一致的诊断；非黑人种族；以及不存在以下情况：接触肾毒性药物、充血性心力衰竭或肾前性AKI。在验证样本中的797例患者（平均年龄65.6岁）中，10.6%患有HN，3.3%患有HNRI。在低风险组的223例患者中，7例（3.1%）患有HN，1例（0.4%）患有HNRI（需要筛查223例患者才能发现1例HNRI）。在该组中，临床团队未知的RUS偶然发现为0。在高风险组中，15.7%患有HN，4.7%患有HNRI。
在成年AKI住院患者中，特定因素可识别RUS检查时不太可能患有HN或HNRI的患者。
