NephroPOCUS

Time to update the #VExUS resources pinned thread 🧵📌 1/ Tweetorial on image acquisition. #POCUS #MedEd twitter.com/NephroP/status…

#NephMadness #POCUS special commentary on NephroPOCUS.com - 🔗nephropocus.com/2026/03/20/poc…

#NephMadness People often ask if our courses can “certify” them in POCUS. I say workshops, no matter whether they are 1 day, 2 day, or 5 day, are just the starting point. Skill comes from deliberate practice, repetition, and clinical integration. #POCUS is a skill set. Not a shortcut.

#NephMadness #Nephpearls #POCUS is a key component of the hemodynamic puzzle 🧩. But keep your clinical senses open 👁️ - images gain value only when integrated with clinical data and individualized to the patient.

Of course, formulae like this aren’t needed in most patients but it’s helpful to be familiar with more pieces of the puzzle and how they’re interpreted in the right clinical context rather than limiting the skillset (those who are learning #POCUS & already comfortable with fundamentals). From a nephrology standpoint, it can be especially useful in scenarios like patients with LA enlargement from a high CO state rather than LAP, as a pre-check before starting norepinephrine in HRS (I work in liver ICU), or for longitudinal outpatient monitoring where B-lines might be absent at rest.

@NephroP @TaweevatA I think these formulas are a lot of fun and great to think about physiology in relation to Doppler flow, but how much does this really add over left atrial size, B lines? Sometimes pocus has the risk of the rabbit hole.

#Nephmadness #POCUS #Nephpearls The formula 👇provides a simplified linear estimate of left atrial pressure (LAP) in mmHg, but has moderate correlation at best with invasively measured pressures and significant limitations in specific patient populations. Specific clinical scenarios where E/e' is unreliable include: - Mitral annular calcification - distorts tissue Doppler measurements - Severe mitral regurgitation - alters E-wave velocity independent of LAP - Tachycardia and atrial fibrillation - beat-to-beat variability and absent A-waves - must average multiple beats - Constrictive pericarditis - dissociation between intracardiac and intramyocardial pressures - Hypertrophic cardiomyopathy - poor correlation with direct LA pressure - Advanced heart failure with reduced EF - no correlation with PCWP changes - Cardiac resynchronization therapy/ventricular dyssynchrony - regional wall motion abnormalities affect e' - Normal hearts - E/e' shows flat response to variable filling pressures

@drmohansai Great to see this 👏 But I’m not really sure how to use RRI in practice for early AKI detection or what to actually do with that information 🙂

I am so happy to see Nephrologists in India expanding their skill set from IVC checks only to a holistic approach of VExUS/Lung USG etc. @NephroP

Tissue Doppler e' and a' waves

Mitral E/A (Trans-mitral pulsed wave Doppler)

@AmirKazory #NephMadness

Discussing fluid management in the critically ill, while the focus is often on de-escalation vs de-resuscitation and medical therapy vs extracorporeal strategies, attention inevitably shifts to the need for objective assessment and monitoring of volume status. #POCUS @NephroP

100% accurate. The problem with crystalloids is that the administration is often a brainstem generated reflex for all kinds of dumb reasons and complications of inappropriate administration are rarely blamed on the fluids because it’s considered largely “safe”.

#Nephmadness #POCUS IV fluids are used so routinely that it’s easy to forget they’re actually drugs. Like any drug, we should first define the patient’s problem (i.e., establish an indication), set a therapeutic goal (i.e., what's the stop-point?), and then choose the appropriate type and dose of fluid.

📢 IV Curso de Ecografía Integral en el Paciente Renal @parctauli 📅 8-10 Jun 26 🔝 3 días intensivos de PoCUS: ✅Renal ✅Cardio ✅Pulmonar ✅VExUS ✅TSA y periférico ✅Paratiroides ✅D.Peritoneal ✅Muscular y nutrición 🔗 tauli.cat/hospital/pocus… @SENefrologia @sengndi @NephroP

RVSP (right ventricular systolic pressure) is an echo-derived estimate of pulmonary artery systolic pressure calculated from the tricuspid regurgitation velocity using the Bernoulli equation. In the absence of RV outflow obstruction, RVSP ≈ PASP, making it a useful noninvasive marker of pulmonary hypertension (PH). Elevated RVSP and PH are independent predictors of mortality and cardiovascular events across the spectrum of kidney disease. In meta-analysis, PH was associated with increased all-cause mortality in CKD (RR 1.44), dialysis patients (RR 2.32), and kidney transplant recipients (RR 2.08). In the CRIC study, PH conferred a 38% increased risk of death and 23% increased risk of cardiovascular events, with significantly higher risk when PASP exceeded 55 mm Hg. Combined pre- and post-capillary PH portends the worst survival in CKD patients. In critically ill patients with AKI requiring continuous renal replacement therapy, 66% had elevated RVSP (≥40 mm Hg), with higher prevalence in AKI compared to ESRD patients (68% vs 57%). PH is an important consideration in kidney transplant evaluation - severe PH (PASP >60 mm Hg) may impact candidacy, and right heart catheterization is recommended when echocardiographic PASP ≥50 mm Hg. Management focuses on volume optimization, treatment of underlying cardiovascular disease, and in hemodialysis patients with recurrent hypotension, consideration of transition to peritoneal dialysis.

RVSP #Nephmadness #Nephpearls #POCUS

@Kevin34050619 x.com/NephroP/status…

@NephroP 🤔 Is it a false lumen in a dissected desc. aorta?

#NephMadness #POCUS quiz What's the mobile structure that the hand is pointing to?

Answer: mirror image artifact Animation courtesy: onlinejase.com/article/S0894-…

@WendelBraga4 @NephroP @NephroP is pointing out a mirror artifact that occurs when sound waves reflect off a thick smooth surface rather than travel through the surface to image what is on the other side. The machine thinks it’s a true image & makes a copy of actual anatomy on the far side of reflector

@Kevin34050619 👍 If it were true pulsatility, you’d see clear flickering. This is just a subtle shift in color intensity, probably reflecting respiratory variation.

@NephroP 😅 I almost got it right... I caught the inverted colours but thought it also looked a bit pulsatile so went for mild congestion. 🙄

#Nephmadness #Nephpearls #VExUS #POCUS answer: It’s normal. The color map here is inverted, meaning red is away from the probe and blue toward it (the opposite of the usual BART rule). If the map wasn’t inverted, then I’d lean toward portal hypertension rather than cardiac congestion because an all-blue portal vein would be pretty unlikely in congestion.