Gaudreau-Simard Mathilde, Ruller Sydney, Dann Melissa, Woo Michael Y, Mallick Ranjeeta, Mcinnes Matthew D F, Clark Edward G, Evans Jessica
Division of General Internal Medicine, Department of Medicine, The Ottawa Hospital, 1053 Carling Ave, Ottawa, ON, Canada.
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
J Gen Intern Med. 2025 Jul 9. doi: 10.1007/s11606-025-09704-2.
The etiology of acute kidney injury (AKI) can be divided into pre-renal, renal, and post-renal causes. Ultrasound is the test of choice to identify post-renal AKI. While ultrasound is routinely used in the assessment of AKI, obstructive AKI is rare, leading to concerns of potential test overutilization.
Our primary aim is to describe patterns of use of imaging in patients admitted to hospital with AKI and to determine whether imaging patterns reflect risk of obstruction. Our secondary aim is to identify the role of point-of-care ultrasound (POCUS) when assessing patients with AKI.
This is a retrospective cohort study.
Patients admitted to internal medicine with AKI over a 12-month period at a large tertiary care academic center.
Our outcome variables were radiology-performed ultrasound, computed tomography (CT), or point-of-care ultrasound (POCUS), presence or absence of hydronephrosis and urological intervention.
The proportion of patients with imaging was highest among those with a high-risk score and lowest in patients with a low-risk score (66.0% versus 52.2%). For radiology ultrasound specifically, the rate was 19.5% in low-risk patients and 17.7% in high-risk patients. The prevalence of hydronephrosis among patients at low, moderate and high risk for hydronephrosis was 7.1%, 8.5% and 19.7%, respectively and the rate of urological intervention was 1.4%, 1.2% and 3.8%, respectively. In moderate to high-risk patients, POCUS had a sensitivity of 86.7% and specificity of 90.0% for the identification of hydronephrosis.
In our cohort, nearly 20% of radiology ultrasounds are ordered in patients with a low risk of obstructive uropathy, despite low rates of hydronephrosis and hydronephrosis requiring intervention in this group. With a sensitivity of 86.7% and specificity of 90.0% in patients at moderate to high risk of obstruction, POCUS may support clinical decision making in patients with AKI.
急性肾损伤（AKI）的病因可分为肾前性、肾性和肾后性。超声是识别肾后性AKI的首选检查。虽然超声在AKI评估中常规使用，但梗阻性AKI罕见，这引发了对潜在检查过度使用的担忧。
我们的主要目的是描述因AKI入院患者的影像学检查使用模式，并确定影像学模式是否反映梗阻风险。我们的次要目的是确定即时超声（POCUS）在评估AKI患者时的作用。
这是一项回顾性队列研究。
在一家大型三级医疗学术中心，12个月内因AKI入住内科的患者。
我们的结局变量是放射科进行超声检查、计算机断层扫描（CT）或即时超声（POCUS）、是否存在肾积水以及泌尿外科干预。
高危评分患者中进行影像学检查的比例最高，低危评分患者中最低（66.0%对52.2%）。具体就放射科超声而言，低危患者的检查率为19.5%，高危患者为17.7%。肾积水低危、中危和高危患者中肾积水的患病率分别为7.1%、8.5%和19.7%，泌尿外科干预率分别为1.4%、1.2%和3.8%。在中高危患者中，POCUS识别肾积水的敏感性为86.7%，特异性为90.0%。
在我们的队列中，近20%的放射科超声检查是针对梗阻性肾病低风险患者开具的，尽管该组肾积水及需要干预的肾积水发生率较低。对于梗阻中高危患者，POCUS敏感性为86.7%，特异性为90.0%，可能有助于支持AKI患者的临床决策。
