الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The role of point-of-care ultrasonography (POCUS) in the assessment and management of patients with acute kidney injury (AKI) in the emergency department has been the focus of our study. We aimed to evaluate the diagnostic accuracy of POCUS, particularly in combination with renal ultrasonography and inferior vena cava (IVC) assessment, and explore its associations with clinical and laboratory parameters.
In our study, conducted at Menoufia University Hospital, we prospectively examined 92 patients presenting with AKI between September 2022 and August 2023. We established inclusion and exclusion criteria, conducted thorough history taking, and utilized standardized protocols for assessment and management using the ABCDE approach. Laboratory investigations, arterial blood gases, and 12-lead ECGs were performed to ascertain the severity and etiology of AKI based on KDIGO criteria.
Our findings provided a comprehensive overview of the demographic and clinical characteristics of the study population. The mean age of 60 years, with a slight male predominance, reflected established patterns associated with AKI. Comorbidities such as hypertension, diabetes, and chronic kidney disease were prevalent, underscoring their significance in AKI development. Clinical characteristics including heart rate, respiratory rate, urine output, and back pressure varied, highlighting the heterogeneity of AKI presentations.
We employed Cohen’s Weighted Kappa analysis to assess the agreement between POCUS diagnoses and final diagnoses, revealing substantial overall agreement across different AKI categories. Notably, POCUS demonstrated high accuracy in diagnosing prerenal causes, post-renal etiologies, and renal pathologies. Multivariate analysis identified Glasgow Coma Scale (GCS), total leukocyte count (TLC), platelet count, and blood pH as significant predictors of IVC diameter, providing valuable insights into hemodynamic status.
Furthermore, our study elucidated associations between POCUS diagnoses and clinical and laboratory parameters. Renal POCUS diagnoses showed strong associations with chronic kidney disease, anuria, and electrolyte imbalances, underlining the diagnostic capabilities of POCUS in identifying underlying renal pathologies and guiding clinical management.
Despite the strengths of our study, including its prospective design and comprehensive approach, certain limitations must be acknowledged. The single-center nature and modest sample size may limit the generalizability of our findings. Additionally, operator expertise and potential inter-operator variability in POCUS examinations should be considered.
Our study underscores the clinical utility of POCUS in the assessment and management of AKI in the emergency department. POCUS emerges as a valuable tool for rapid and accurate diagnosis, facilitating timely interventions and improving patient outcomes. Further research, including multicenter studies with larger cohorts, is warranted to validate and expand upon our findings, ultimately optimizing the use of POCUS in emergency settings.