Point-of-care ultrasonography in cirrhosis-related acute kidney injury:How I do it  

作　　者：Abhilash Koratala 

机构地区：[1]Division of Nephrology,Department of Medicine,Medical College of Wisconsin,Milwaukee,WI 53226,United States

出　　处：《World Journal of Critical Care Medicine》2024年第2期137-149,共13页世界重症医学杂志

基　　金：Supported by KidneyCure and the American Society of Nephrology’s William and Sandra Bennett Clinical Scholars Grant.

摘　　要：Discerning the etiology of acute kidney injury(AKI)in cirrhotic patients remains a formidable challenge due to diverse and overlapping causes.The conventional approach of empiric albumin administration for suspected volume depletion may inadvertently lead to fluid overload.In the recent past,point-of-care ultrasonography(POCUS)has emerged as a valuable adjunct to clinical assessment,offering advantages in terms of diagnostic accuracy,rapidity,cost-effectiveness,and patient satisfaction.This review provides insights into the strategic use of POCUS in evaluating cirrhotic patients with AKI.The review distinguishes basic and advanced POCUS,emphasizing a 5-point basic POCUS protocol for efficient assessment.This protocol includes evaluations of the kidneys and urinary bladder for obstructive nephropathy,lung ultrasound for detecting extravascular lung water,inferior vena cava(IVC)ultrasound for estimating right atrial pressure,internal jugular vein ultrasound as an alternative to IVC assessment,and focused cardiac ultrasound for assessing left ventricular(LV)systolic function and identifying potential causes of a plethoric IVC.Advanced POCUS delves into additional Doppler parameters,including stroke volume and cardiac output,LV filling pressures and venous congestion assessment to diagnose or prevent iatrogenic fluid overload.POCUS,when employed judiciously,enhances the diagnostic precision in evaluating AKI in cirrhotic patients,guiding appropriate therapeutic interventions,and minimizing the risk of fluid-related complications.

关 键 词：POINT-OF-CARE ULTRASOUND HEMODYNAMIC Right atrial pressure Hepatorenal NEPHROLOGY 

分 类 号：R692[医药卫生—泌尿科学]