Turk M, Robertson T, Koratala A. Point-of-care ultrasound in diagnosis and management of congestive nephropathy. World J Crit Care Med 2023; 12(2): 53-62 [PMID: 37034023 DOI: 10.5492/wjccm.v12.i2.53]
Corresponding Author of This Article
Abhilash Koratala, MD, Associate Professor, Division of Nephrology, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, United States. akoratala@mcw.edu
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Crit Care Med. Mar 9, 2023; 12(2): 53-62 Published online Mar 9, 2023. doi: 10.5492/wjccm.v12.i2.53
Point-of-care ultrasound in diagnosis and management of congestive nephropathy
Michael Turk, Thomas Robertson, Abhilash Koratala
Michael Turk, Thomas Robertson, Department of Medicine, Allegheny Health Network, Pittsburgh, PA 15222, United States
Abhilash Koratala, Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
Author contributions: Turk M and Roberson T drafted the manuscript; Koratala A designed and reviewed the manuscript, and revised it for critical intellectual content; all authors have read and approved the final version.
Conflict-of-interest statement: All the authors declare no potential conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Abhilash Koratala, MD, Associate Professor, Division of Nephrology, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, United States. akoratala@mcw.edu
Received: December 23, 2022 Peer-review started: December 23, 2022 First decision: January 5, 2023 Revised: January 8, 2023 Accepted: February 17, 2023 Article in press: February 17, 2023 Published online: March 9, 2023 Processing time: 73 Days and 21.6 Hours
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.
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.
