Point of Care Ultrasound Training in Nephrology: Twitter Poll as a Modern Tool for Development of an Effective Curriculum.

INTRODUCTION: Point of care ultrasonography (POCUS) is being increasingly recognized as an adjunct to physical examination in the field of nephrology. However, paucity of trained faculty and standardized curricula remain key barriers to widespread adoption of this skill as well as development of reliable quality assessment programs at the institutional level. Herein, we sought to explore the utility of Twitter polls to gain insights into knowledge deficits of the learners for making curricular improvements while simultaneously disseminating POCUS pearls and pitfalls. METHODS: A series of 57 single-question polls were tweeted over a 12-month period, each containing an ultrasound image or a video asking for correct interpretation. These were sent out from the Twitter handle of NephroPOCUS.com (@NephroP), an online POCUS education tool. The answer and a brief explanation were shared in a subsequent tweet at the end of the voting period. Information on the percentage of correct answers, Tweet impressions, and engagements was collected and analyzed by the pre-determined difficulty level (I-III) and the organ/learning objective being tested. RESULTS: The number of responses per poll was 228 ± 94.6 (mean ± SD), and the percentage of correct responses was 57.9 ± 17.5 (mean ± SD). 16 (of 57) polls received less than 50% correct responses, of which 8 belonged to level III difficulty. The learning objectives that received the least number of correct responses in the kidney, cardiac, lung, vascular, and other categories were identification of end-stage kidney (16.2% correct answers), right pleural effusion on the parasternal short axis view of the heart (29%), right pleural effusion from the subxiphoid window (39%), grading of systemic venous congestion (27.3%), and identification of ascites on the right lateral chest window (15%), respectively. The overall engagement rate was 6.96%, which was above the median for health and higher education-related tweets on Twitter. Targeted didactic material was developed based on these results, published on various open-access nephrology education platforms. CONCLUSIONS: Twitter polls aid in identifying the knowledge gaps among POCUS learners. Information obtained from the polls can be used to improve POCUS-related curricula and develop targeted educational material to facilitate remote learning.

Point of care renal ultrasonography for the busy nephrologist: A pictorial review.

The application of bedside ultrasonography in routine clinical practice has dramatically evolved over the last few decades and will likely continue to grow as technological advances lead to enhanced portability and affordability of the equipment. Despite mounting interest, most nephrology fellowship training programs do not offer formal training in renal ultrasonography and there is inertia among practicing nephrologists to adopt this skill as a practice-changing advancement. Lack of familiarity with the topic is considered a key reason for this inertia. Understanding of basic ultrasound physics, instrumentation, principles of optimal image acquisition and interpretation is critical for enhanced efficiency and patient safety while using this tool. Herein, we provide a brief overview of the basic principles of diagnostic renal ultrasonography as well as introduction to common sonographic pathologies encountered in day-to-day nephrology practice with illustrative images.

Bladder stone: "Must know" ultrasonographic signs.

Point-of-care ultrasonography by non-radiology physicians has become a valuable bedside diagnostic tool. As urolithiasis is one of the commonest indications for sonographic examination, physicians need to be familiar with the characteristic features of stones, that is, acoustic shadowing on gray scale and twinkle artefact on color doppler imaging.

Point-of-care renal ultrasound: Interpret with care.

Renal vascular malformations may mimic hydronephrosis on gray-scale ultrasound and can be easily differentiated using color doppler imaging. Non-radiology physicians performing point-of-care renal ultrasound should be aware of this finding to avoid mismanagement.

Blood finds its own way: Axillary vein thrombosis with extensive chest-wall collaterals.

Hemodialysis catheters are associated with upper extremity deep vein thrombosis, and chronic venous occlusion leads to the formation of collateral pathways. Knowledge of these pathways aids in accurate interpretation of upper extremity venograms. Arteriovenous fistula is the preferred access for chronic hemodialysis, and long-term use of catheters should be avoided.

Kidney hump, no need to jump!

Dromedary hump is a prominent focal bulge on the lateral border of the left kidney caused by splenic impression, which can mimic renal neoplasm. It is a benign anatomic variant and exhibits the same imaging characteristics as adjacent renal cortex with normal blood flow pattern on Doppler sonography.

Subcutaneous hematomas from prophylactic heparin use.

Heparin is an anticoagulant, which is frequently used in hospitalized patients for prophylaxis of deep vein thrombosis (DVT). Subcutaneous administration of heparin may lead to complications such as bruising, hematoma, and pain at the injection site. Hematomas can develop without visible bruising, as in our case.

Extrarenal pelvis mimicking hydronephrosis: a case for caution.

Extrarenal pelvis is an anatomical variant that appears as a large hypoechoic mass just outside the renal sinus and can be confused with hydronephrosis, especially on a point-of-care renal ultrasound. Unlike hydronephrosis, it is not associated with dilated calyces, parenchymal thinning, hydroureter, or enlarged kidney per se.

Chronic Kidney Disease in Pregnancy.

With the increasing prevalence of chronic kidney disease (CKD) worldwide, the number of pregnant women with various degrees of renal dysfunction is expected to increase. There is a bidirectional relation between CKD and pregnancy in which renal dysfunction negatively affects pregnancy outcomes, and the pregnancy can have a deleterious impact on various aspects of kidney disease. It has been shown that even mild renal dysfunction can increase considerably the risk of adverse maternal and fetal outcomes. Moreover, data suggest that a history of recovery from acute kidney injury is associated with adverse pregnancy outcomes. In addition to kidney dysfunction, maternal hypertension and proteinuria predispose women to negative outcomes and are important factors to consider in preconception counseling and the process of risk stratification. In this review, we provide an overview of the physiologic renal changes during pregnancy as well as available data regarding CKD and pregnancy outcomes. We also highlight the important management strategies in women with certain selected renal conditions that are seen commonly during the childbearing years. We call for future research on underexplored areas such as the concept of renal functional reserve to develop a potential clinical tool for prognostication and risk stratification of women at higher risk for complications during pregnancy.