Role of point of care ultrasound and parathormone hormone in management of acute kidney injury in emergency department

Abstract

ABSTRACT Background Role of point of care ultrasound in management of acute kidney injury (AKI) is still unclear. The discrimination between AKI and chronic kidney disease (CKD) in ED, especially in the absence of clear CKD history, represents a dilemma. Aim To test the accuracy of POCUS and intact parathormone hormone (iPTH) as differentiators between AKI and CKD, and to investigate the role of POCUS in management of AKI in the ED. Methods This prospective study involved 95 adult patients presented to ED of Alexandria Main University Hospital, with signs and/or symptoms suggesting renal impairment in the absence of prior renal functions tests from April 2022 to December 2022. POCUS was done and iPTH was measured for all enrolled patients. Validity of renal length and iPTH to discriminate AKI and CKD were tested. POCUS were used to identify different underlying causes of AKI. Results Renal length ≤ 9.62 cm could diagnose CKD (Area under curve-AUC 0.926) with 82.46% sensitivity, 92.11% specificity, 94.0% PPV and 77.8% NPV. Intact PTH level > 161 pg/ml could diagnose CKD (AUC 0.844) with 73.17% sensitivity, 92.11% specificity, 90.9% PPV and 76.1% NPV. Conclusion Both renal length and iPTH are accurate tests to differentiate AKI from CKD in ED. POCUS help identifying the different causes of AKI and reaching appropriate management decisions.