Case 1 - AKI - Cr 1200
Indication
The patient had suffered from significant kidney injury, and the history suggest an acute component. Post-renal mechanism should be investigated ASAP.
This was transferred to the tertiary care hospital at night when departmental formal ultrasound cannot be obtained. Hence, PoCUS was deployed.
Image Acquisition
Both kidneys were imaged first to look for evidence of hydronephrosis. Subsequently, the bladder was imaged. In this case, the IVC was imaged last to evaluate the patient's "volume status".
The patient had suffered from significant kidney injury, and the history suggest an acute component. Post-renal mechanism should be investigated ASAP.
This was transferred to the tertiary care hospital at night when departmental formal ultrasound cannot be obtained. Hence, PoCUS was deployed.
Image Acquisition
Both kidneys were imaged first to look for evidence of hydronephrosis. Subsequently, the bladder was imaged. In this case, the IVC was imaged last to evaluate the patient's "volume status".
Interpretation:
Bilateral hydronephrosis were present which post-renal mechanism for renal injury. The bladder was empty.
The IVC features did indicate the patient was hypovolemic.
Clinical Synthesis:
Given the IVC findings, the decision was to volume expand the patient as the patient was likely to be volume tolerant.
Given a foley was inserted and the bladder was empty, if the inciting etiology was a bladder outlet obstruction, the post-renal mechanism would have been relieved. Overtime, the renal function would recover as the hydronephrosis relieve. Upon seeing bilateral hydronephrosis, the patient was questioned on obstructive urinary symptomatology for which he denied. Hence, a CT abdomen and pelvis was obtained to look for the point(s) of obstruction.
The CT revealed no stone or obstruction points. Hence, Urology was consulted for further management of this patient.
The major change in management for this particular case we how rapid the diagnosis was made (PoCUS was deployed as soon as the patient arrived) and contraction of the time-to-decision (Urology was consulted once CT was obtained).
Bilateral hydronephrosis were present which post-renal mechanism for renal injury. The bladder was empty.
The IVC features did indicate the patient was hypovolemic.
Clinical Synthesis:
Given the IVC findings, the decision was to volume expand the patient as the patient was likely to be volume tolerant.
Given a foley was inserted and the bladder was empty, if the inciting etiology was a bladder outlet obstruction, the post-renal mechanism would have been relieved. Overtime, the renal function would recover as the hydronephrosis relieve. Upon seeing bilateral hydronephrosis, the patient was questioned on obstructive urinary symptomatology for which he denied. Hence, a CT abdomen and pelvis was obtained to look for the point(s) of obstruction.
The CT revealed no stone or obstruction points. Hence, Urology was consulted for further management of this patient.
The major change in management for this particular case we how rapid the diagnosis was made (PoCUS was deployed as soon as the patient arrived) and contraction of the time-to-decision (Urology was consulted once CT was obtained).