(Ultrasound Review) When is it necessary to perform renal ultrasound examinations in intensive care units on patients with acute or acute-on-chronic renal failure? That was the question addressed in an article by radiologists at University of North Carolina, Chapel Hill, published in the Journal of Ultrasound in Medicine.
In order to exclude hydronephrosis, doctors at their hospital routinely requested renal sonography for patients under intensive care with acute renal insufficiency. In most cases obstructive uropathy was not clinically indicated.
In order to assess the effectiveness and cost of these examinations, the authors studied 105 sonograms from 104 patients. Patients had to be older than 18 years, without any history of renal calculi or obstruction, and without renal transplant. The serum creatinine levels were greater than 1.5 mg/dL, and no patient had an abdominal or pelvic mass or recent abdominal trauma. Over the study period, only one case of hydronephrois was demonstrated. This was a mild case in a 90-year-old woman whose renal insufficiency was attributed to dehydration. Her problems resolved with volume resuscitation.
A number of nonspecific and incidental renal sonographic findings were reported including echogenic renal parenchyma, ascites, simple cysts and pleural effusions. "The total cost of the examinations was $13,350.75 (U.S)," they reported. Given the low diagnostic yield rates for hydronephrosis they asserted that such examinations were a costly waste of resources. In addition, they suggested that such renal studies "may potentially necessitate further imaging evaluations to establish the benignity of incidental findings."
The authors concluded "in critically ill patients with acute renal failure and no physical findings suggesting obstructive uropathy, renal sonography to evaluate for hydronephrosis is probably not indicated." They report that this is the case regardless of the age, sex, medical or surgical status of the patient and also blood urea nitrogen-creatinine ratio.
"Renal sonography in the intensive care unit, when is it necessary?"H F Keyserling et al
Dept of radiology, University of North Carolina, Chapel Hill, NC
J Ultrasound Med 2002 May; 21:517-520
By Ultrasound Review
May 29, 2002
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