RENAL SONOGRAPHY - CAN IT BE USED MORE SELECTIVELY IN THE SETTING OF AN ELEVATED SERUM CREATININE LEVEL

The objectives of our study were to (1) assess the outcomes resulting from the use of sonography in patients referred to our institution's u ltrasound laboratory for an elevated serum creatinine level and (2) de termine relevant clinical parameters in these patients to better triag e them for sonography. We retrospectively identified and determined ou tcomes of 60 patients (20 women, 40 men; mean age, 61 years; range, 33 to 100 years) referred for sonographic evaluation because of an incre ased serum creatinine level (greater than or equal to 1.3 mg/dL). Ultr asound findings (hydronephrosis, renal size, and echogenicity) were co rrelated with clinical outcomes. Twenty-one patients (35%) had hydrone phrosis, with 14 of these patients confirmed to be obstructed and five not obstructed, Two were indeterminate for obstruction, Eight of 14 o bstructed patients were successfully treated, All obstructed patients had a suggestive history for obstruction with at least one of the foll owing: pelvic mass (n = 9), stone disease (n = 4), or flank pain (n = 1). Only 2 of 44 patients, who were not obstructed, had any of these p arameters (statistically significant difference, P < 0.0001), Thirty o f the patients, who were not obstructed, had more likely alternative c auses for renal failure, with sonography having no effect on patient m anagement. Renal size and echogenicity had little effect on patient ma nagement, Sonography was efficacious in guiding management in patients with a suggestive history for obstruction (eg, pelvic mass, stone dis ease, or flank pain) but not in most patients who had no suggestive hi story and other more likely causes for renal failure. (C) 1997 by the National Kidney Foundation, Inc.