Point-of-care ultrasound in diagnosis and management of congestive nephropathy

Abstract

Congestive nephropathy is kidney dysfunction caused by the impact of elevated venous pressures on renal hemodynamics. As a part of cardiorenal syndrome, the diagnosis is usually made based on history and physical examination, with findings such as jugular venous distension, a third heart sound, and vital signs as supporting findings. More recently, however, these once though objective measures have come under scrutiny for their accuracy. At the same time, bedside ultrasound has increased in popularity and is routinely being used by clinicians to take some of the guess work out of making the diagnosis of volume overload and venous congestion. In this mini-review, we will discuss some of the traditional methods used to measure venous congestion, describe the role of point-of-care ultrasound and how it can ameliorate a clinician’s evaluation, and offer a description of venous excess ultrasound score, a relatively novel scoring technique used to objectively quantify congestion. While there is a paucity of published large scale clinical trials evaluating the potential benefit of ultrasonography in venous congestion compared to gold standard invasive measurements, more study is underway to solidify the role of this objective measure in daily clinical practice.

Keywords: Ultrasound; Point-of-care ultrasonography; Doppler; Venous excess ultrasound score; Congestion; Hemodynamics; Heart failure; Nephrology

Core Tip: Congestive nephropathy denotes kidney dysfunction in fluid overload states as a result of venous congestion. Conventional methods to assess congestion at the bedside lack sensitivity and diagnostic accuracy. Point-of-care ultrasound is emerging as an enhancement to physical examination for objective assessment of congestion and guide therapy. Future research should focus on its impact on practical outcomes such as freedom from congestive symptoms, quality of life, and recurrent hospitalizations.