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Basic Lung Ultrasonography for the Nephrologist

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Imaging in Nephrology

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Abstract

Hyperhydration is characterized by increased quantity and altered distribution of body fluids. Fluid overload is frequently found in critically ill patients with acute kidney injury (AKI) and in heart failure patients and is associated with adverse outcomes. Although physical examination is still the first choice for the assessment of the hydration state, it is imprecise and often unreliable. Nowadays novel techniques are employed, sometimes together, in a comprehensive assessment strategy previously proposed as the “5B” approach: body weight changes, blood volume online monitoring, bioimpedance spectroscopy (BIS), B-natriuretic peptide, and body ultrasound (US), which includes inferior vena cava (IVC) diameter measure and lung US (LUS). The modern LUS has extended its field of clinical application from cardiology and intensive care setting to hemodialysis patients since the clinical evaluation alone has proven to be rather imprecise in estimating the correct “dry weight.” B-line detection by LUS has recently been confirmed to be superior in sensitivity to clinical signs of fluid overload such as lung crackles and peripheral edema. Furthermore, LUS has shown a greater predictive power for hydration-related cardiovascular morbidity and mortality than NYHA score or echocardiography. Based on evidence, LUS can be considered a valid diagnostic and prognostic tool for pulmonary congestion measurement in both extracorporeal and peritoneal dialysis patients.

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Author information

Authors and Affiliations

  1. Institute of Clinical Physiology, National Research Council, Pisa, Italy

    Luna Gargani

  2. Department of Emergency Medicine, San Luigi Gonzaga University Hospital, Orbassano, Torino, Italy

    Giovanni Volpicelli

  3. Department of Radiology, San Luigi Gonzaga University Hospital, Orbassano, Torino, Italy

    Luciano Cardinale

Authors
  1. Luna Gargani
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  2. Giovanni Volpicelli
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  3. Luciano Cardinale
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Editor information

Editors and Affiliations

  1. Department of Nephrology and Dialysis, “Cannizzaro” Emergency Hospital, Catania, Italy

    Antonio Granata

  2. Department of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy

    Michele Bertolotto

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Gargani, L., Volpicelli, G., Cardinale, L. (2021). Basic Lung Ultrasonography for the Nephrologist. In: Granata, A., Bertolotto, M. (eds) Imaging in Nephrology. Springer, Cham. https://doi.org/10.1007/978-3-030-60794-4_27

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  • DOI: https://doi.org/10.1007/978-3-030-60794-4_27

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  • Online ISBN: 978-3-030-60794-4

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