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Review
. 2022 Feb 1;7(Kidney):35-44.
doi: 10.24908/pocus.v7iKidney.14989. eCollection 2022.

Ultrasonography in Acute Kidney Injury

Andrew A Moses  1 , Hilda E Fernandez  1
Affiliations
Review

Ultrasonography in Acute Kidney Injury

Andrew A Moses et al. POCUS J. .
No abstract available

Keywords: Acute kidney injury; POCUS; Point-of-care ultrasound; Ultrasound; nephrology.

PubMed Disclaimer

Conflict of interest statement

None

Figures

Figure 1
Figure 1. Normal kidney on ultrasound. Sagittal view of normal left and right kidney. Note the isoechoic nature of the cortex with the liver and spleen with hyperechoic sinus fat in the center. The hypoechoic medullary pyramids surround the sinus fat. Image from Koratala, A. POCUS Gallery. Renal Fellow Network. Accessed November 27, 2020. https://www.renalfellow.org/pocus-gallery/ Used with Permission
Figure 2
Figure 2. Moderate hydronephrosis. The usually hyperechoic sinus is pushed and thinned as the pelvis swells with hypoechoic urine, making the center of the kidney dark. Note the connection with the ureter, confirming that it is the urinary tract swelling and not parapelvic cysts.Image courtesy of Abhilash Koratala. renalfellow.org/pocus-gallery. Used with permission.
Figure 3
Figure 3. 3. Increased Echogenicity. A) Right kidney long axis, hyperechoic cortex compared to liver, however cortex has normal thickness and length normal for size. Patient found to have positive serologies and proliferative lupus nephritis. B) Right kidney, long axis. Patient with advanced chronic kidney disease. Note the hyperechoic renal cortex and thin parenchyma with both cortex and medulla <1cm. C) Left kidney of patient with ATN, biopsy proven, from myoglobinuric kidney injury. Note the increased echogenicity of the cortex with increased differentiation of the medulla and cortex. Images courtesy of Abhilash Koratala Nephropocus.com Used with permission.
Figure 4
Figure 4. Bladder ultrasound. A) Normal transverse ultrasound of a full bladder. B) Decompressed bladder around an indwelling urinary catheter. Notice a small amount of hypoechoic urine around the catheter which is normal. C) Indwelling urinary catheter within a non-empty bladder. Note there is still a lot of anechoic urine within the bladder. This measured as >200 mL indicating improper drainage of urine. The indwelling urinary catheter was replaced and urinary flow resumed. D) Pelvic ascites mimicking bladder. Ascites is a common false positive for bladder scanners which mistake it for urine. On ultrasound we see the indwelling urinary catheter surrounded by a decompressed bladder (arrow). Superficial to this, one can see pelvic ascites interdigitating among abdominal viscera and tracking into the paracolic gutters. Images courtesy of Abhilash Koratala. Renalfellow.org/pocus-gallery. Used with permission.
Figure 5
Figure 5. Flowsheet on the approach to AKI and ultrasound. Using this flowsheet and starting with a kidney ultrasound, one can decipher most causes of AKI.
Figure 6
Figure 6. Bilateral Kidney and IVC: Case 1. A) The right kidney appears more echogenic compared with the adjacent liver and has increased medullary pyramid differentiation consistent with ATN. B) Left kidney also with increased echogenicity and differentiation. C) Liver, IVC, and aorta in view. IVC collapsibility index >50%. JVP on ultrasound also found to be at the level of the clavicle (not shown).
See this image and copyright information in PMC

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