ROLE OF POCUS IN DETECTION OF EMPHYSEMATOUS PYELONEPHRITIS IN COVID WARDS: OUR INSTITUTIONAL EXPERIENCE

Abstract

introduction: Our institution has been at the forefront in the management of COVID 19 cases since the beginning of the pandemic. With more than 2000 dedicated covid beds at the peak of 2nd wave and a daily inpatient admission of 350 and outpatient census of 1000, resource availability was at its lowest,necessitating judicious use. With an increased incidence of emphysematous pyelonephritis in covid patients, we present our experience with use of point of care ultrasound(POCUS) in screening and management of emphysematous pyelonephritis Materials And Methods: Abdominal pain is a symptoms in upto 15% of covid 19 patients . A wide variety of diseases can present with abdominal pain, ruling out urological emergencies takes precedence. We used POCUS in screening of 97 patients with loin pain, fever who were on O2 support. Patients were screened for signs of parenchymal irregularities(including dirty echoes), hydronephrosis, renal abscess, perinephric collection. Patients with no major changes were followed up with conservative management. Patients with clear parenchymal changes and highly suspicious signs were only suggested plain CT scans to conrm changes.POCUS was also used to insert a Percutaneous nephrostomy in patients as a bedside procedure Results: Of the 97 patients screened using POCUS, only 28 had lesions suspicious of infection and parenchymal changes and only 13 had suspicion of gas or obstructive features in kidney. CT scan was prescribed to 25 patients which revealed 11 cases of emphysematous pyelonephritis. 3 patients were conservatively managed , 7 needed percutaneous drainage which was done as a bedside procedure and 1 patient with bilateral disease was taken up for emergency stenting Conclusion: While ultrasound has a poor sensitivity compared to computed tomography in detecting parenchymal changes, easy availability,portability,no radiation risk make ultrasound a RELIABLE tool in times of the pandemic.