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Despite the fact that thekidney ultrasound is generally obtained as one of multiple recommendations whenevaluating AKI, the benefit of kidney ultrasound is not clear. The post-renalcauses of AKI are not very common. Itadds to the cost and can subject patients to unnecessary work-ups by revealingincidentalomas. How often, then, is the ultrasound useful? In order to assess theprevalence of the post-renal AKI and determine a cost-effective use of theultrasound, a single-center case-control study was conducted.Their conclusion is that theprevalence of hydronephrosis requiring stenting or nephrostomy placement wasonly 0.4% in the low-risk group. The number to screen to find a case of urinaryobstruction was 223. At what cost? In our institution the kidney ultrasoundwithout Doppler costs $600. It costs $133,800 to find one case.Who is the low-risk grouppatient? Based on the multivariate analysis, a patient was considered low-riskif he or she did not have a history of hydronephrosis and had no more than oneof the following: 1. Recurrent UTI2. Diagnosis to suspectedobstruction (BPH, abdominal or pelvic cancer, one functional kidney,neurogenic bladder, pelvic surgery)3. Non-African American 4. Absence of:  exposure to the following medications (ASA,diuretics, ACEI or IV vancomycin), congestive heart failure, or pre-renal AKI.The study has limitations. Notall AKI patients were studied. The cases requiring non-surgical interventions werenot counted. If we would have to implement this strategy, we don’t know whatthe cost of missing some cases of obstruction would be.However, the implication isthat we should not routinely order kidney ultrasound on every patient with AKI,particularly those in the low-risk group. In this era of cost constraint on medicine,less is usually more…Or, here is what you can do.If your place has an ultrasound on the floor, with a little training you canhave a quick look at the kidneys just to rule out obstruction in low riskpatients. You acquire one more diagnostic skill, your students have one morefun on round, and your hospital saves significant amount of money!Posted by Tomoki Tsukahara