Nephrology, Dialysis and Transplantation Unit, Ospedali Riuniti, Reggio Calabria, Italy.
CNR-IFC, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Nefrologia-Ospedali Riuniti, 89100, Reggio Calabria, Italy.
J Nephrol. 2020 Apr;33(2):335-341. doi: 10.1007/s40620-019-00666-3. Epub 2019 Nov 5.
Lung congestion and frank pulmonary edema are established complications of acute kidney injury (AKI) and early detection and monitoring of lung congestion may be useful for the clinical management of AKI patients.
We compared standardized clinical criteria (including lung crackles and peripheral edema grading) and simultaneous chest ultrasound (US) to detect lung congestion in a series of 39 inpatients with AKI.
At baseline, twelve patients (31%) were clinically euvolemic and twelve presented clear-cur cardiovascular congestion (31%) by clinical criteria. Fifteen patients (38%) were hypovolemic. The median number of US-B lines in patients with cardiovascular congestion was much higher (50, inter-quartile range 27-99) than in euvolemic (14, IQR 11-37) and hypovolemic patients (7, IQR 3-16, P < 0.001). Remarkably, a substantial proportion of asymptomatic euvolemic (66%) and hypovolemic (46%) patients had lung congestion of moderate to severe degree (> 15 US-B lines) by lung US. Crackles severity and the number of US-B lines over time were inter-related (Spearman's ρ = 0.38, P < 0.01) but the agreement (Cohen k statistics) between the two metrics was unsatisfactory. Forty-eight percent of patients had lung congestion of moderate to severe degree by lung US and this estimate by far exceeded that by clinical criteria (32%).
This pilot study shows that chest US has potential for the detection of lung congestion at a pre-clinical stage in AKI. The results of this pilot study form the basis for a clinical trial testing the usefulness of this technique for guiding lung congestion treatment in patients with AKI.
肺充血和明显的肺水肿是急性肾损伤（AKI）的既定并发症，早期发现和监测肺充血可能对 AKI 患者的临床管理有用。
我们比较了标准化的临床标准（包括肺部爆裂音和外周水肿分级）和同时进行的胸部超声（US），以检测 39 名 AKI 住院患者的肺充血。
在基线时，12 名患者（31%）临床容量正常，12 名患者根据临床标准表现出明确的心血管充血（31%）。15 名患者（38%）为低血容量。心血管充血患者的 US-B 线中位数明显较高（50，四分位距 27-99），而容量正常（14，四分位距 11-37）和低血容量患者（7，四分位距 3-16，P<0.001）。值得注意的是，相当一部分无症状容量正常（66%）和低血容量（46%）患者的肺部超声显示中重度肺充血（>15 条 US-B 线）。肺部超声的 US-B 线数量和时间之间存在相关性（Spearman ρ=0.38，P<0.01），但两种方法之间的一致性（Cohen k 统计量）并不令人满意。48%的患者肺部超声显示中重度肺充血，这一估计值远远超过临床标准（32%）。
这项初步研究表明，胸部超声在 AKI 中具有在临床前阶段检测肺充血的潜力。这项初步研究的结果为一项临床试验奠定了基础，该试验测试了该技术在指导 AKI 患者肺充血治疗中的有用性。
