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| Author, year, country, study | Level of evidence/Study design Participants/Inclusion criteria | Intervention and Control Groups | Key outcome and results | Critical appraisal, Results |
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Ozmen CA et al, 2010 Turkey
(Title: Ultrasound as a diagnostic tool to differentiate acute from chronic renal failure.)
Clinical Nephrology, Vol. 74 – No. 1/2010 (46-52) | Level of evidence: II
Prospective Observational cohort study. Study compares Sonographic results of patients with ARF and CKD and controls.
127 consecutive patients with serum creatinine >3 milligrams(mg) per decilitre(dl) and 33 healthy volunteers
(i) Renal length along longest axis of the left and right kidney measured and mean calculated.
Echo intensity of the cortex measured as Grades I to III which is comparison with echogenicity of liver | 127 patients with serum creatinine level >3mg/dl
33 Health workers with no known Renal disease | Group AKI N=62
(i) Renal length 112+/-14mm
(ii) Cortical echogenicity Grade 0: 19 Grade I: 33 Grade II: 10 Grade III: 0
Group CKD N=65
(i) Renal length 90±15mm
(ii) Cortical echogenicity
Grade 0: 4
Grade I: 32
Grade II: 27
Grade III: 7
Group C Control n= 33
(i) Renal length 107+/-6mm
(ii) Cortical echogenicity
Grade 0: 28
Grade I: 5
Grade II: 0
Grade III: 0 | (i) P value calculated.
(ii) ROC (Receiver operating characteristic curve ) analysis performed
(iii) Area under curve AUC for parenchymal thickness is 0.724
(iv) AUC for renal length is 0.873
(v) Statistical methods explained. Student T test for parametric values, Chi 2 test for frequencies were used.
(vi) Small study, single centre,
(vii) Radiologists performing ultrasound were blinded. |
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Chase Canavero et al, 2015, USA
(Title: Blast from the past- using PTH to differentiate acute versus chronic kidney disease)
J Nephrol Ther 2015, 5:1 | Level of evidence: IV
Case series
Reports on 6 patients with either acute kidney injury or Chronic kidney disease
Intact parathyroid hormone assay measured in renal failure. Cases followed and blood tests: Creatinine, calcium, phosphorus, potassium, iPTH repeated. | Case series of 6 patients with either acute kidney injury or Chronic kidney disease.
(i) AKI: 4 patients
(ii) CKD: 2 Patients | Group AKI: n= 4
do not have persistent high iPTH level
Group CKD: n= 2
High creatinine observed in CKD is associated with a persistent elevated PTH level. | (i) Case series
(ii) Small sample size.
(iii) iPTH level showed Sensitivity of 88% & Specificity of 89%
(iv) Single centre, no uniform protocol, no p value calculated
(v) Weakness: iPTH level repeated only in 2 cases and trend of the parathyroid hormone not well established.
(vi) Limitation and further scope clearly mentioned. |
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S Ozmen R Danis et al, 2007, Turkey
(Title: Parathyroid hormone as a marker for the differential diagnosis of acute and chronic renal failure.)
Renal Failure, 29:509–512, 2007 | Level of evidence: II
Study design: Prospective observational study
To establish the potential role of iPTH as a marker for a differential
diagnosis of AKI and CKD compared with diagnosis based on relevant past medical history, radiological findings and lab tests
Inclusion criteria:
Prospective cohort
122 patients with serum creatinine > 2 milligram(mg) per decilitre (dl) | (i) AKI n=64,
(ii) CKD n=58 | A cut off for intact parathyroid hormone at 170 picogram (pg) per millilitre (ml)
(i) High sensitivity (88%)
(ii) High specificity (89%)
(iii) Positive predictive value 88%
(iv) negative predictive value of 89%
(v) AUC for iPTH 0.92
Group AKI n=64
iPTH (pg/mL): 102 ± 64
Serum creatinine
(mg/dL): 6.3 ± 4.2
Serum BUN (mg/dL): 89 ± 34
Group CKD n= 58
iPTH (pg/mL): 430 ± 280
Serum creatinine
(mg/dL): 7.7 ± 4.1
Serum BUN (mg/dL): 91 ± 40 | (i) Prospective trial with clear protocol.
(ii) Sample size calculated at a significance level of 5%, power of 80% and assumption of sensitivity of 80-95%.
(iii) Statistical methods explained. Student T test for parametric values. Chi 2 test for frequencies used.
(iv) Sampling technique NOT mentioned.
(v) Inclusion and exclusion criteria NOT mentioned.
(vi) Results summarized as Sensitivity, specificity, PPV. +ve (8) or –ve (0.1) LR Not calculated.
(vii) In ROC analysis AUC = 0.92 Single centre study mentions the need for Large multicentre RCT. |
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Bennidor Raviv, 2014, Israel
(Title: Renal ultrasound in the evaluation of acute kidney injury in the emergency department)
American Journal of Clinical Medicine Research, 2014, Vol. 2, No. 5, 103-105 | Level of evidence= III
Retrospective study
Aim of the study is
(i) To evaluate effectiveness of ultrasound in the evaluation of AKI in Emergency Department
(ii) To find out stratifying factors that will help to identify patients who will be benefitted by ultrasound. | (i) n = 137 Male: female:77:56 mean age 70 years
(ii) Inclusion criteria: 18 years old and with AKI identified as rise of at least 50% in baseline creatinine or at least 0.3 mg% from baseline creatinine | (i) Ultrasound defined as pathologic: if demonstrated obstructive aetiology for AKI.
(ii) Normal US 121; Pathologic US: 16
(iii) Normal US group: Serum creatinine 3.88 + 2.84 Pathologic US group serum creatinine 4.30 +4.49
(iv) 11.7 % of AKI patients identified as due to obstructive renal failure | Material and methods explained in detail.
Table 2 describes the influence of independent parameters on ultrasound result. There is no foot note to explain symbols.
Results need more and clear explanation.
Logistic regression method mentioned in materials and methods but not reported. Results in text and tables match
Limitation: small study, wide confidence interval
Suggested large multicentre prospective study |
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M Winston et al, 1977, Los Angeles, California USA
(Title: Ultrasonography in the management of unexplained renal failure)
Journal of Clinical Ultrasound,1978, Vol 6, 1-72 | Level of evidence: IV
Case series
Ultrasound imaging as a first diagnostic procedure in acute unexplained renal failure to identify obstructive component and the potential for recovery. | Case series of 7 patients | Patients identified as CKD, Polycystic kidney, Bilateral hydro nephrosis, bladder tumour, cancer prostate | (i) Small number of cases analysed.
(ii) No impact of cost analysed
(iii) No uniform protocol in the study
(iv) Narrative description of cases
(v) No sensitivity or specificity calculated.
(vi) Single centre, no uniform protocol, no p value calculated |
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