Test characteristics of point-of-care ultrasonography in patients with acute kidney injury

Mathilde Gaudreau-Simard; Tana Saiyin; Matthew D F Mcinnes; Sydney Ruller; Edward G Clark; Krista Wooller; Elaine Kilabuk; Alan J Forster; Michael Y Woo

doi:10.1186/s13089-023-00352-3

Test characteristics of point-of-care ultrasonography in patients with acute kidney injury

Ultrasound J. 2024 Feb 22;16(1):15. doi: 10.1186/s13089-023-00352-3.

Authors

Mathilde Gaudreau-Simard^{1

2

3}, Tana Saiyin⁴, Matthew D F Mcinnes^{5

6}, Sydney Ruller⁵, Edward G Clark^{5

4

7}, Krista Wooller^{8

5

4}, Elaine Kilabuk^{8

4}, Alan J Forster^{8

5

4}, Michael Y Woo^{5

9}

Affiliations

¹ Division of General Internal Medicine, The Ottawa Hospital-General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada. magaudreau@toh.ca.
² Ottawa Hospital Research Institute, Ottawa, ON, Canada. magaudreau@toh.ca.
³ Department of Medicine, University of Ottawa, Ottawa, ON, Canada. magaudreau@toh.ca.
⁴ Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁵ Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁶ Department of Diagnostic Imaging, University of Ottawa, Ottawa, ON, Canada.
⁷ Division of Nephrology, The Ottawa Hospital, Ottawa, ON, Canada.
⁸ Division of General Internal Medicine, The Ottawa Hospital-General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
⁹ Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.

Abstract

Background: Acute kidney injury is a common disorder that is associated with significant morbidity and mortality. Point-of-care ultrasonography (PoCUS) is an imaging modality performed at the bedside and is used to assess for obstructive causes of acute kidney injury. Little is known about the test characteristics of PoCUS in patients with acute kidney injury.

Objective: Our primary objective was to describe the test characteristics of PoCUS for the detection of hydronephrosis in patients presenting with acute kidney injury at our centre. Our secondary objective was to describe the current rate of use of PoCUS for this indication.

Results: In total, 7873 patients were identified between June 1, 2019 and April 30, 2021, with 4611 meeting inclusion criteria. Of these, 94 patients (2%) underwent PoCUS, and 65 patients underwent both PoCUS and reference standard, for a total of 124 kidneys included in our diagnostic accuracy analysis. The prevalence of hydronephrosis in our cohort was 33% (95% CI 25-41%). PoCUS had a sensitivity of 85% (95% CI 71-94%) and specificity of 78% (95% CI 68-87%) for the detection of hydronephrosis.

Conclusion: We describe the test characteristics of PoCUS for the detection of hydronephrosis in a cohort of patients with acute kidney injury. The low uptake of this test presents an opportunity for quality improvement work to increase its use for this indication.

Keywords: AKI; Diagnostic accuracy; PoCUS; Point-of-care ultrasound; QI.

Grants and funding

TOHAMO/Ottawa Hospital