Gogula NSAR, Koratala A. Lung ultrasound in nephrology: Basics, applications, limitations, and future directions. World J Nephrol 2025; 14(4): 110491 [DOI: 10.5527/wjn.v14.i4.110491]
Corresponding Author of This Article
Abhilash Koratala, Associate Professor, Senior Researcher, Division of Nephrology, Medical College of Wisconsin, 8701 W Watertown Plank Road, Room A 7633, Milwaukee, WI 53226, United States. akoratala@mcw.edu
Research Domain of This Article
Medicine, General & Internal
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 Nephrol. Dec 25, 2025; 14(4): 110491 Published online Dec 25, 2025. doi: 10.5527/wjn.v14.i4.110491
Lung ultrasound in nephrology: Basics, applications, limitations, and future directions
Naga Sai Akhil Reddy Gogula, Abhilash Koratala
Naga Sai Akhil Reddy Gogula, Molecular Physiology Institute, Duke University School of Medicine, Durham, NC 27710, United States
Abhilash Koratala, Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
Author contributions: Gogula NSAR conducted an independent literature review and drafted the initial manuscript; Koratala A critically reviewed and revised the manuscript for intellectual content.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
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, Associate Professor, Senior Researcher, Division of Nephrology, Medical College of Wisconsin, 8701 W Watertown Plank Road, Room A 7633, Milwaukee, WI 53226, United States. akoratala@mcw.edu
Received: June 9, 2025 Revised: July 12, 2025 Accepted: November 5, 2025 Published online: December 25, 2025 Processing time: 199 Days and 7.4 Hours
Abstract
Point-of-care ultrasonography (POCUS) is increasingly recognized as a valuable extension of the physical exam, offering real-time bedside insights to support clinical decision-making. In nephrology, lung ultrasound (LUS) is gaining prominence for its ability to assess extravascular lung water and guide fluid management, especially in patients with end-stage renal disease. This narrative review highlights current applications, technical aspects, and limitations of LUS in nephrology. Studies such as the Lung Water by Ultrasound-Guided Treatment in Haemodialysis Patients trial indicate that LUS-guided ultrafiltration may help improve blood pressure control, reduce pulmonary congestion and acute heart failure events in dialysis patients. Simplified approaches like the 8-zone protocol have shown diagnostic accuracy comparable to the traditional 28-zone method, improving feasibility in clinical practice. Nonetheless, limitations exist, including reduced specificity in non-cardiogenic lung conditions and under recognition of right-sided congestion when used in isolation. A comprehensive hemodynamic assessment requires integrating LUS with inferior vena cava ultrasound, focused cardiac ultrasound, and venous Doppler. Successful implementation depends on structured training and an understanding of potential interpretation challenges. Looking ahead, streamlined protocols, multimodal integration, and standardized training will be key to establishing POCUS as a core tool in nephrology.
Core Tip: Point-of-care ultrasonography, especially lung ultrasound (LUS), is becoming an essential bedside tool in nephrology. It enables dynamic, noninvasive assessment of fluid status and extravascular lung water, particularly in dialysis patients. Evidence from trials like Lung Water by Ultrasound-Guided Treatment in Haemodialysis Patients highlights its potential to guide ultrafiltration, improve blood pressure control, and reduce heart failure events. Simplified protocols, such as 8-zone LUS, offer diagnostic efficiency with greater feasibility. However, LUS should not be used in isolation. Combining it with other modalities like inferior vena cava, cardiac, and venous Doppler ultrasound ensures a more accurate hemodynamic picture.
