Microchip Versus Piezoelectric Point of Care Ultrasonography for Pulmonary and Vena Cava Evaluation in Patients With Acute Kidney Injury.

Introduction: Point-of-care ultrasonography (POCUS) has emerged as an important tool for examining critically ill patients. POCUS devices have become progressively smaller and more accessible, transforming medical practice, and reducing costs. One technological breakthrough was the development of ultraportable scanners with microchip technology, which utilize a probe connected to a smartphone or tablet and incorporate a mobile application that employs artificial intelligence to assist in the interpretation of acquired images. The aim of this study was to compare the accuracy of ultrasound microchip technology with traditional piezoelectric crystal ultrasonography. We analyzed 2 volume status parameters in intensive care unit (ICU) patients with acute kidney injury (AKI) who were receiving kidney replacement therapy (KRT). These parameters were the extravascular pulmonary water, using the lung B-lines; and the inferior vena cava collapsibility index (IVCi). Methods: Fifty critically ill patients met the study criteria. Lung POCUS quantified B-lines in 8 quadrants. The IVCi was measured using the maximum and minimum diameters during a respiratory cycle. Both technologies were sequentially employed in a randomized fashion to acquire the parameters at 2 different time points: before the initiation of KRT (T0) and 60 minutes after the procedure had commenced (T60). We calculated the correlation and agreement between the 2 ultrasound scanner modalities. Results: The correlation between the 2 technologies for evaluating lung B-lines showed strong positive coefficients, ⍴ = 0.96 and ⍴ = 0.93 at T0 and T60, respectively (P < 0.001 for both). The correlation for IVCi was ρ = 0.70 and ρ = 0.87 at T0 and T60, respectively (P < 0.001 for both). The Bland-Altman plots showed agreement between ultrasound methods for IVCi calculation and B-line quantification. For IVCi calculation at T0, bias was +2.69 (SD: 10.6) (95% confidence interval [CI]: -18.13 to +23.52); at T60, bias was 3.28 (SD: 10.23) (95% CI: -16.77 to +23.34). For B-line quantification, the analysis yielded a bias of -0.3 (SD: 2.73), with a 95% CI of -5.66 to +5.06 at T0; and a bias of 0.2 (SD: 3.23), with a 95% CI of -6.14 to +6.54 at T60. Conclusion: Our study observed a good correlation and agreement between microchip and piezoelectric-based ultrasound modalities in evaluating the presence of pulmonary B-lines and inferior vena cava (IVC) dynamics in patients with AKI. Microchip ultrasound, in addition to being portable, user-friendly, and cost-effective, consistently delivers bedside parameters for volume assessment that are comparable to those obtained through POCUS using piezoelectric transducer-based ultrasonography.

A real-world prospective study on dialysis-requiring acute kidney injury.

BACKGROUND: Current information about acute kidney injury (AKI) epidemiology in developing nations derives mainly from isolated centers, with few quality multicentric epidemiological studies. Our objective was to describe a large cohort of patients with dialysis-requiring AKI derived from ordinary clinical practice within a large metropolitan area of an emerging country, assessing the impact of age and several clinical predictors on patient survival across the spectrum of human life. METHODS: We analyzed registries drawn from 170 hospitals and medical facilities in Rio de Janeiro, Brazil, in an eleven-year period (2002-2012). The study cohort was comprised of 17,158 pediatric and adult patients. Data were analyzed through hierarchical logistic regression models and mixed-effects Cox regression for survival comparison across age strata. RESULTS: Severe AKI was mainly hospital-acquired (72.6%), occurred predominantly in the intensive care unit (ICU) (84.9%), and was associated with multiple organ failure (median SOFA score, 11; IQR, 6-13). The median age was 75 years (IQR, 59-83; range, 0-106 years). Community-acquired pneumonia was the most frequent admission diagnosis (23.8%), and sepsis was the overwhelming precipitating cause (72.1%). Mortality was 71.6% and was higher at the age extremes. Poor outcomes were driven by age, mechanical ventilation, vasopressor support, liver dysfunction, type 1 cardiorenal syndrome, the number of failing organs, sepsis at admission, later sepsis, the Charlson score, and ICU admission. Community-acquired AKI, male gender, and pre-existing chronic kidney disease were associated with better outcomes. CONCLUSIONS: Our study adds robust information about the real-world epidemiology of dialysis-requiring AKI with considerable clinical detail. AKI is a heterogeneous syndrome with variable clinical presentations and outcomes, including differences in the age of presentation, comorbidities, frailty state, precipitation causes, and associated diseases. In the cohort studied, AKI characteristics bore more similarities to upper-income countries as opposed to the pattern traditionally associated with resource-limited economies.

Emergent Arboviruses and Renal Transplantation: A Global Challenge.

In recent years, Zika, Chikungunya, Dengue, West Nile Fever, and Yellow Fever epidemics have generated some concerns. Besides difficulties related to vector control, there are challenges related to behavior of pathologies not yet fully understood. The transplanted population requires additional care due to immunosuppressive drugs. Furthermore, the potential risk of transmission during donation is another source of uncertainty and generates debate among nephrologists in transplant centers. Do the clinical outcomes and prognoses of these infections tend to be more aggressive in this population? Is there a risk of viral transmission via kidney donation? In this review article, we address these issues and discuss the relationship between arbovirus and renal transplantation.