Young Allen, Crawford Todd, Pierre Alejandro Suarez, Trent Magruder J, Fraser Charles, Conte John, Whitman Glenn, Sciortino Christopher
Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Sheikh Zayed Tower 1800 Orleans Street, Baltimore, MD, 21287, USA.
Division of Cardiac Surgery, University of Pittsburgh Medical Center (UPMC) Presbyterian, Suite C-700, 200 Lothrop St. Pittsburgh, Pittsburgh, PA, 15213, USA.
J Cardiothorac Surg. 2017 Sep 2;12(1):75. doi: 10.1186/s13019-017-0637-x.
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.
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.
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.
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.
肾脏超声检查是评估急性肾损伤（AKI）流程的一部分。本研究的目的是评估肾脏超声检查在发生AKI的心脏术后患者中的临床应用价值。
我们对2010年1月19日至2016年3月19日在一家机构接受肾脏超声检查以评估AKI的90例心脏手术术后患者进行了回顾性研究。我们查阅了医护人员的记录，以确定肾脏超声检查是否改变了治疗方案。我们将改变定义为：给予晶体液或胶体液、加用正性肌力药或血管升压药，或对肾脏系统进行程序性干预。
研究患者的平均年龄为68±13岁。90例患者中有48例（53.3%）术前患有不同严重程度的慢性肾脏病。48例患者（53.3%）肾脏超声检查结果正常但有偶然发现，31例患者（34.4%）有肾脏疾病的超声证据。10例患者（11.1%）因图像显示不佳导致超声检查结果有限，1例患者（1.1%）有轻度右侧肾盂积水。未发现患者有梗阻性尿路病或肾动脉狭窄。仅90例患者中的4例（4.4%）的临床治疗方案发生了改变，其中3例患者接受了液体冲击治疗，1例患者接受了液体冲击治疗并加用了正性肌力药。超声检查结果未导致任何血管或泌尿外科手术。
尽管肾脏超声检查常用于AKI的检查，但我们的研究表明，肾脏超声检查在管理心脏术后患者方面益处不大。在心脏手术人群中，这种诊断方式应受到审视，而不应被视为一种通用的检查方法。
