Point-of-care renal ultrasound: Are longitudinal views of the kidney alone sufficient to rule out hydronephrosis?

OBJECTIVE

Point-of-care ultrasound for the detection of hydronephrosis is frequently used by emergency physicians. The aim of this study was to assess the accuracy of longitudinal views of the kidney compared with a combination of longitudinal and transverse views of the kidney on emergency physician-performed renal point-of-care ultrasound to detect hydronephrosis.

METHODS

This was a retrospective case-control study of patients who received a renal point-of-care ultrasound examination performed and interpreted as hydronephrosis in the emergency department (ED). These were then matched with a cohort of kidneys from different patients without hydronephrosis. Longitudinal ultrasound views and transverse ultrasound views were reviewed for the presence of hydronephrosis by ultrasound-trained emergency physicians. The gold standard of hydronephrosis was an overall interpretation based on the complete ultrasound examination consisting of both transverse and longitudinal views by ultrasound-trained emergency physicians.

RESULTS

Renal point-of-care ultrasound exams from 140 kidneys performed in the ED were enrolled in the study. The sensitivity and specificity of longitudinal ultrasound views compared with a combination of longitudinal and transverse ultrasound views of the kidney as a gold standard were 84.3% (95% confidence interval [CI], 77.2-89.9) and 92.9% (95% CI, 87.3-96.5), the positive predictive value was 92.2% (95% CI, 86.1-96.2), and the negative predictive value was 85.5% (95% CI, 78.9-90.7). The positive and negative likelihood ratios were 11.8 (95% CI, 6.5-21.5) and 0.2 (95% CI, 0.1-0.2), respectively.

CONCLUSIONS

Longitudinal views of the kidney on ultrasound showed good sensitivity and specificity to detect the presence of hydronephrosis compared with a combination of longitudinal and transverse ultrasound views of the kidney. However, a combination of longitudinal and transverse ultrasound views may still be warranted in high-risk patients or in those with inadequate visualization of the upper pole of the kidney.