Point-of-care ultrasound: Uniting cardiology and nephrology at the bedside

Abstract

Cardiorenal syndrome reflects a complex interplay between cardiac and renal dysfunction, often compounded by fragmented management between cardiology and nephrology. Traditional phrases such as “the heart likes it dry and the kidneys like it wet” oversimplify care and perpetuate misconceptions about diuretic use and fluid management. Emerging evidence points to venous congestion rather than reduced cardiac output as a key driver of worsening renal function and adverse outcomes in heart failure. This article blends current evidence with the authors’ perspective and clinical experience to explore the role of point-of-care ultrasound (POCUS) in the hemodynamic assessment of cardiorenal dysfunction, highlighting practical frameworks and tools. Conventional bedside assessment tools are limited, and static markers such as serum creatinine and physical signs can be misleading. POCUS provides a dynamic, physiology-based evaluation by integrating focused cardiac imaging, venous Doppler, lung ultrasound, and abdominal views. Frameworks such as “pump, pipes, and leaks” and scoring systems like venous excess ultrasound enable real-time visualization and quantification of congestion, shifting practice from assumption-based to data-driven care and fostering alignment between specialties. As training opportunities expand and supporting evidence grows, POCUS should be regarded as a core clinical skill in the management of cardiorenal dysfunction, with the potential to improve diagnostic precision and guide targeted therapy.

Keywords: Ultrasound; Point-of-care ultrasound; Congestion; Cardiorenal; Venous excess ultrasound

Core Tip: Cardiorenal syndrome is often managed through conflicting specialty-specific approaches rooted in outdated assumptions about fluid status and creatinine trends. Emerging data emphasize venous congestion, not just reduced cardiac output, as a key driver of renal dysfunction. Traditional tools lack sensitivity and physiologic specificity. Point-of-care ultrasound (POCUS) offers a real-time, integrative method to assess forward flow, congestion, and extravascular fluid using focused cardiac, venous Doppler, and lung ultrasound. This physiology-based approach enables individualized care, clarifies rising creatinine during decongestion, and fosters consensus across specialties. POCUS should be seen not only as a tool but as a shared clinical language.