Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Department of Nephrology, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy.
Blood Purif. 2022;51(12):967-971. doi: 10.1159/000522652. Epub 2022 Mar 18.
Acute kidney injury (AKI) is a clinical syndrome caused by a multitude of hemodynamic, toxic, and structural insults to the kidney, and portends worse patient outcomes. Despite careful history taking, physical examination, and analysis of laboratory data, a void is evident in the diagnostic process and clinical monitoring of AKI. Point-of-care ultrasonography (POCUS) is a limited ultrasound study performed by the clinician at bedside as an adjunct to physical examination. Growing body of evidence points to POCUS as a powerful tool in a variety of clinical settings. Herein, we discuss how nephrologist-performed POCUS has the potential to provide answers to focused questions that we encounter in diagnosis and management of patients with AKI. From excluding hydronephrosis to providing real-time insights into hemodynamics, incorporation of POCUS helps integrate all the pieces of patient data and formulate individualized treatment plans. Future studies are needed to evaluate the impact of multi-organ POCUS on AKI-related pragmatic patient outcomes, the potential of this technique to stratify the risk and to identify patients with different levels of severity of AKI and different pathophysiological signatures.
急性肾损伤（AKI）是由多种血流动力学、毒性和结构因素对肾脏的损害引起的临床综合征，预示着患者的预后更差。尽管进行了仔细的病史采集、体格检查和实验室数据分析，但在 AKI 的诊断过程和临床监测中仍存在空白。即时床旁超声检查（POCUS）是临床医生在床边进行的有限超声研究，作为体格检查的辅助手段。越来越多的证据表明，POCUS 在多种临床环境中是一种强大的工具。本文讨论了肾脏病医生进行的 POCUS 如何有可能为我们在 AKI 患者的诊断和治疗中遇到的重点问题提供答案。从排除肾积水到提供实时血流动力学见解，POCUS 的应用有助于整合患者所有数据，并制定个体化治疗计划。需要进一步的研究来评估多器官 POCUS 对与 AKI 相关的实际患者结局的影响，该技术分层风险以及识别 AKI 严重程度不同和不同病理生理特征的患者的潜力。
