Confused, pending dialysis

This 32 year old gentleman was being treated in resus with acute confusion. He had reported declined to have dialysis due to religious objections.

His blood results were pending (typically take around 24 hours here). He was confused and sweating profusely which made his scan quiet difficult to undertake

His right kidney, looked like this. I think it was a little small, but it was definitively brighter (more echogenic) and no evidence of hydronephrosis. You can also see a small silver of free fluid

Left kidney, showing reduced size and increaed echogenity as compared to liver.



His right kidney had a very similar appearance

Very bright small kidney with small amount of free fluid.


On a scan of lungs and abdomen no other source of confusion was suggested. He went on to have dialysis and made some improvement before being lost of follow up.

I am not an expert on kidney ultrasound so did a quick search. According to this paper, size is much less predictive than the brightness. This is good news for the amateur POCUS kidney scanner as measuring size is a bit more tricky and I am never fully confident that I am measuring at maximum axis possible.

However, with the spleen and liver there as reference points this is much more simple.


Learning points

  • Consider both acute and decompensated chronic conditions in low resource settings.
  • Non-communicable disease tends to affect younger patients than in higher resource settings.
  • Brighter cortex of kidneys is more predictive of CKD than size and easier to identify.