Short summary

Ultrasonography is a widely uses tool in the clinic. The last years the use of b-US as part of the clinically assesement has grown.

It is relevant to evaluate the potential findings in af patients population suspicious to kidney involvemnt and the validity of b-US, to determine weather the use og b-US should be implemented in the clinic.

Rationale

Ultrasonography has shown to be a valuable tool in the assessment of the acute patient and is already a part of the clinical examination in multiple areas. A review shows a 15% decrease in hospitalization days when applying ultrasound to the clinical evaluation of patients with suspected heart disease. (1) Similarly a Danish study finds that ultrasound has shown to be useful not only in diagnosing life threating conditions when assessing the heart and lungs, but also efficient in ruling out severe respiratory conditions. (2)

Urinary infection (UVI) and dehydration is a common cause for admission to the ED in elderly patients. (3) UVI is a condition seen in the entire population and often treated without complications. In some cases patients are in a higher risk to develop more severe infections such as pyelonephritis. A Danish study examining patients treated for urosepsis, found hydronephrosis to be the most common abnormality, suggesting a structural cause for upper urinary infection. (4) Hydronephrosis has various causes especially depending on patient population. Patients suspicious to kidney involvement can present with a variety of symptoms not always correlated to severity of their condition. Hydronephrosis is an accounting risk of infection spreading to the renal pelvis or bacteremia.(5) Another outcome is kidney stones, a common condition in patients admitted to the ED. It is a relevant diagnose in patients presenting with renal colic and sign of urinary retention or urinary infection. (6, 7)

A study from United States has found an association between general mortality, hospitalization and revisits to the ED when identifying patients with decreased kidney function identified by serum-creatinine. (8) Because of the heterogenicity in symptoms of patients presenting with urinary infection and the risk of severe progression in patients condition, it is important to reveal clinical important kidney involvement. Hydronephrosis is a potential factor to be incorporated into the primary clinical assessment.  Hydronephrosis is a variable with high sensitivity when diagnosed by non-radiologists in patients already referred to a renal sonography. (9) 

Patients with different signs of kidney involvement are a frequent issue in the ED. A study examining the use of b-US as a diagnostic supplement in the clinical assessment of the patients within 4 hours after admission is therefore relevant. Patients aged 18 years old or more with signs of kidney involvement defined by elevation of S-creatinine or fever combined with flank pain will be included. Pathological findings from the b-US and the clinical evaluation of the patient will be compared to standard clinical assessment. This study differs from other studies by including an unselected group of patients in the ED with potential kidney involvement and comparing the standard clinical assessment to the clinical assessment combined with b-US.

The purpose of the study is to evaluate pathologic findings and accuracy of b-US in an unselected group of patients entering the ED with signs of kidney involvement.

The aim is to evaluate the use of b-US as a supplement to the primary clinical assessment.

Description of the cohort

All patinets aged >18 years who consent.

Patients are included if suspicious to urinary tract infection og urosepsis and fulfill at least one of the following:

- Flnak pain

- Fever

- Creatinine elevation

- Symptoms when urinating/voiding

Data and biological material

All included patients undergo b-US of both kidneys and the bladder.

Bloodsamples include: Sodium, potasium, creatinine and infectious count.

Urine samples undergo basis evaluation. If urine is cultured the result are noted.

All clinicials perform questionnaires to evaluate the use og b-US and potential changes in treatment or further examination.

Collaborating researchers and departments

Department of emergency medicine OUH

• Professor, Annmarie Touborg Lassen, Ph.D, DMSci

Department of emergency medicine OUH

• Associate Professor, Stefan Posth, MD, Ph.D

Department of respiratory medicine OUH

• Associate Professor, Christian Borbjerg Laursen, MD, PhD

Department of radiology, Chief consultant OUH

• Associate Professor, Ole Graumann, MD, PhD