Hydronephrosis - Why do it
Why Renal Ultrasound?
The most common renal related issue that an Internist confront on a daily basis is acute kidney injury. From an etiology elucidation perspective, the first step is to rule out a post-renal mechanism. Unfortunately, neither history nor physical examination are sensitive or specific to detect this.
Compounding this is that post-renal etiologies require invasive measures for alleviation -- whether it be foley insertion, cystoscopy with ureteric stenting by the Urologist, or percuanteous nephrostomy by the Interventional Radiologist. However, with such early intervention the renal injury tends to resolve rapidly.
Hence, the rate limiting step is diagnostic. Rather than awaiting for a departmental study, PoCUS can provide that timely solution at the bedside yielding an immediate answer that will affect management decision. The only clinical question you are attempting to answer is whether hydronephorsis is present or absent (and if the bladder is distended if present) -- nothing else.
Of course, that is not to say that there is no role for departmental study as there are many other entities and subtleties that the Radiologist are trained to notice and interpret.
Compounding this is that post-renal etiologies require invasive measures for alleviation -- whether it be foley insertion, cystoscopy with ureteric stenting by the Urologist, or percuanteous nephrostomy by the Interventional Radiologist. However, with such early intervention the renal injury tends to resolve rapidly.
Hence, the rate limiting step is diagnostic. Rather than awaiting for a departmental study, PoCUS can provide that timely solution at the bedside yielding an immediate answer that will affect management decision. The only clinical question you are attempting to answer is whether hydronephorsis is present or absent (and if the bladder is distended if present) -- nothing else.
Of course, that is not to say that there is no role for departmental study as there are many other entities and subtleties that the Radiologist are trained to notice and interpret.
Take Home Message:
- The purpose of renal PoCUS is to TIMELY investigate for a post-renal mechanism -- hydronephrosis.
- Renal PoCUS is NOT
the comprehesive scan and interpretation of departmental studies