Portal de Periódicos da CAPES

Lung ultrasonography: a novel clinical tool to consider in nephrology

2016; Elsevier BV; Volume: 89; Issue: 3 Linguagem: Inglês

10.1016/j.kint.2015.09.005

1523-1755

Daniel W. Ross, Richard Barnett, Hitesh H. Shah,

Radiation Dose and Imaging

Volume assessment is an important skill when caring for patients undergoing chronic dialysis. Recent research has shown that lung ultrasound can be useful to nephrologists when determining volume status. B-lines seen on lung ultrasound correlate with extravascular lung water and mortality in dialysis patients.1Noble V.E. Murraf A.F. Capp R. et al.Ultrasound assessment for extravascular lung water in patients undergoing hemodialysis.Chest. 2009; 135: 1433-1439Crossref PubMed Scopus (227) Google Scholar, 2Zoccali C. Torino C. Tripepi R. et al.Pulmonary congestion predicts cardiac events and mortality in ESRD.J Am Soc Nephrol. 2013; 24: 639-646Crossref PubMed Scopus (186) Google Scholar A reduction in B-lines after dialysis correlates directly with volume removal.3Vitturi N. Dugo M. Soattin M. et al.Lung ultrasound during hemodialysis: the role in the assessment of volume status.Int Urol Nephrol. 2014; 46: 169-174Crossref PubMed Scopus (45) Google Scholar Evidence also suggests that lung ultrasound can diagnose pulmonary edema more accurately than chest X-ray.4Pivetta E. Goffi A. Lupia E. et al.Lung ultrasound-implemented diagnosis of acute decompensated heart failure in the ED: a SIMEU multicenter study.Chest. 2015; 148: 202-210Crossref PubMed Scopus (240) Google Scholar Therefore, it can impact decisions in both the inpatient and outpatient settings. While ultrasonography can yield valuable information to the nephrologist, nephrology programs in the United States are not required to provide training in performing bedside renal or lung ultrasound during fellowship. Recognizing this deficiency in our program, an ultrasound training course for both faculty and fellows was organized at our institution earlier this year. The 4-hour course was given by our pulmonary and critical care faculty who have expertise in this area. First, there was a didactic session where normal and pathologic findings in the kidneys, bladder, and lungs were reviewed. Then, there was a hands-on session where ultrasonography was performed on standardized patients. Since the training, both nephrology fellows and faculty at our institution have incorporated lung ultrasound into their volume management decisions in the hospital and outpatient settings. Based on our experience, we believe that lung ultrasonography is a useful clinical tool for the nephrologist that can be easily learned.1Noble V.E. Murraf A.F. Capp R. et al.Ultrasound assessment for extravascular lung water in patients undergoing hemodialysis.Chest. 2009; 135: 1433-1439Crossref PubMed Scopus (227) Google Scholar, 2Zoccali C. Torino C. Tripepi R. et al.Pulmonary congestion predicts cardiac events and mortality in ESRD.J Am Soc Nephrol. 2013; 24: 639-646Crossref PubMed Scopus (186) Google Scholar Nephrology fellowship programs should also consider incorporating this training into their curriculum.