1094: UTILITY OF RENAL ULTRASOUND IN GUIDING MANAGEMENT OF ACUTE KIDNEY INJURY

Abstract

Introduction: Although guidelines recommend renal ultrasound in patients with acute kidney injury (AKI) to assess for obstructive etiologies, several studies have suggested that the clinical utility of renal ultrasound for all patients with AKI is undetermined and should be reserved for patients with risk factors for urinary tract obstruction. We looked into the characteristics of patients with a radiology-performed renal ultrasound (radiology US) for AKI to evaluate the frequency of unnecessary exams. Methods: We conducted a retrospective chart review from 6/1/2021 to 6/1/2022 at a single urban teaching hospital of patients admitted to medicine, intensive care unit or cardiac care unit with a rardiology US performed for AKI. We collected baseline demographic data, ultrasound findings, interventions including urethral catheter placement, urologic procedures or hemodialysis (HD), and time from ultrasound order to result. Results: 108 patients were included in this study. The average age was 70.2+- 14.52 and 37% were women. Patients were of diverse race/ethnicity: 22% White, 24% Black, 20% Hispanic and 12% Asian. Nephrology was consulted in 67.6%. KDIGO criteria was met in 80.6%; others had unknown baseline creatinine or had chronic kidney disease. 14 patients (n=14/108, 12%) had a final diagnosis of obstructive AKI. Of these patients, hydronephrosis was initially diagnosed on CT for 4 cases (n=4/35, 11%) and POCUS for 3 patients (n=3/8, 0.375%), and radiology US for 7 patients. Of the 11 patients who had hydronephrosis in radiology US, 4 patients had a foley placed prior to ultrasound. Only 3 out of the 11 patients required urological intervention and 1 started HD. Time from AKI detection to ordering radiology US was median 1 day [IQR 1,3] and time from radiology US order to final report was 16.97 hours [IQR 4.89, 27.39]. Conclusions: Out of 108 patients who had a radiology US for AKI, only 8 patients resulted in a change in management, specifically placement of a foley. In addition, 7 patients had hydronephrosis diagnosed on an alternate imaging study. Our study showed that it takes approximately 2 days for radiology US to result. Prevalence of hydronephrosis was low and few had change in management. Moreover, our study suggests that alternative imaging for AKI may result earlier than radiology renal US.