Core IM | Internal Medicine Podcast #203 POCUS for AKI & Dialysis | Real Cases That Changed Management
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Mar 23, 2026 Dr. Jeffrey Cott, nephrologist and intensivist who teaches practical POCUS for kidney care. He walks through real cases: using renal, lung, and venous ultrasound to spot obstruction, guide diuresis despite rising creatinine, distinguish COPD from volume overload in dialysis patients, and assess new AV fistula usability at the bedside.
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POCUS Revealed Obstructive AKI Mistaken For Tumor Lysis
- Jeffrey Cott used bedside POCUS on a chemo patient with K 7 and creatinine jump to 4.5 and found bilateral hydronephrosis with a large bladder, prompting Foley placement instead of immediate dialysis.
- Labs initially suggested tumor lysis syndrome, but ultrasound revealed obstructive nephropathy from BPH and avoided unnecessary dialysis.
Start With Post‑Void Residual Before Formal Arbus
- Use a risk tool and start with a post-void residual before ordering a formal renal bladder ultrasound for every AKI to avoid unnecessary tests.
- If you can perform POCUS yourself you can get faster answers than waiting for nursing bladder scans or formal imaging.
POCUS Can Detect Early Chronic Kidney Changes
- Renal ultrasound features like increased echogenicity, thin cortex, and smaller kidney size can indicate chronic kidney disease even when creatinine looks normal.
- These sonographic changes may precede measurable GFR decline and reveal subclinical chronicity.