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International Journal of Nephrology
Volume 2017 (2017), Article ID 3756857, 13 pages
https://doi.org/10.1155/2017/3756857
Review Article

Focused Real-Time Ultrasonography for Nephrologists

Division of Nephrology, Department of Medicine, University of Southern California, Los Angeles, CA, USA

Correspondence should be addressed to Elaine M. Kaptein; ude.csu@nietpake

Received 1 August 2016; Revised 9 October 2016; Accepted 1 November 2016; Published 2 February 2017

Academic Editor: Anil K. Agarwal

Copyright © 2017 Matthew J. Kaptein and Elaine M. Kaptein. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We propose that renal consults are enhanced by incorporating a nephrology-focused ultrasound protocol including ultrasound evaluation of cardiac contractility, the presence or absence of pericardial effusion, inferior vena cava size and collapsibility to guide volume management, bladder volume to assess for obstruction or retention, and kidney size and structure to potentially gauge chronicity of renal disease or identify other structural abnormalities. The benefits of immediate and ongoing assessment of cardiac function and intravascular volume status (prerenal), possible urinary obstruction or retention (postrenal), and potential etiologies of acute kidney injury or chronic kidney disease far outweigh the limitations of bedside ultrasonography performed by nephrologists. The alternative is reliance on formal ultrasonography, which creates a disconnect between those who order, perform, and interpret studies, creates delays between when clinical questions are asked and answered, and may increase expense. Ultrasound-enhanced physical examination provides immediate information about our patients, which frequently alters our assessments and management plans.