#203 POCUS for AKI & Dialysis | Real Cases That Changed Management

#203 POCUS for AKI & Dialysis | Real Cases That Changed Management

Author: Core IM Team March 23, 2026 Duration: 29:19

A dialysis patient with a chronic cough: is it COPD, or are they still volume overloaded?

A patient with AKI and hyperkalemia says they’re still peeing — does that rule out post-obstructive AKI?

A patient arrives in the ED with uremic symptoms and a newly created AV fistula. Can you safely use it, or do you need to place a temporary dialysis catheter?

And the classic inpatient dilemma: your heart failure patient looks better after diuresis, but the creatinine is rising. Is it time to stop, or should you keep going?


🔹Sponsor: Pain Management and Opioids Adaptive Learning Free Online Course by NEJM Group: https://cme-info.nejm.org/core-im/

See here for Neph Madness details 

See here for the POCUS region of NephMaddness

VOTE here to build your bracket!

🔹Transcript and Shownotes:


00:52 | What is NephMadness?

02:19 | Detecting post-renal obstruction in a patient who reported normal urination

11:26 | POCUS for discharge or continue diurese

17:25 | Distinguishing COPD from volume overload in a dialysis patient using lung ultrasound

23:55 | Assessing AV fistula maturity at the bedside to potentially avoid placing a temporary dialysis line


Along the way, we discuss practical ways clinicians can use renal, lung, and venous ultrasound to clarify uncertain clinical situations and make faster decisions at the bedside.


If you’ve ever paused on rounds, wondering “what should we do next?” in a patient with kidney disease, this episode explores how POCUS can help answer that question.


Tags: CoreIM, Internal Medicine, Medical Education, Nephrology, AKI Management, POCUS



Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840

Our Sponsors:
* Check out Quince: https://quince.com/coreim
* Use code FIGSRX for a great deal: https://wearfigs.com


Advertising Inquiries: https://redcircle.com/brands

Privacy & Opt-Out: https://redcircle.com/privacy

Ever find yourself in the middle of a busy day, wondering about the 'why' behind a common treatment or needing a clear way to think through a complex diagnosis? That's the space where Core IM | Internal Medicine Podcast lives. Created by the Core IM Team, this isn't just a lecture series; it's a practical companion for clinicians, students, and anyone curious about the inner workings of medical practice. Each episode is structured into distinct segments that tackle different facets of the clinical world. You'll hear "5 Pearls" for concise, immediately useful takeaways, and "Mind the Gap" explores the evidence and reasoning behind our everyday decisions. When management gets tricky, "Gray Matters" steps in to untangle the thought process, while "Hoofbeats" focuses on sharpening diagnostic acumen. Finally, "At the Bedside" brings it all together, addressing the real and often nuanced challenges faced in patient care. The conversation throughout this podcast is grounded, thoughtful, and driven by a genuine desire to deepen understanding beyond the textbook. It’s about connecting the dots between knowledge and application, making the intricate landscape of internal medicine a bit more navigable, one discussion at a time.
Author: Language: English Episodes: 100

Core IM | Internal Medicine Podcast
Podcast Episodes
#194: Severe Hypertriglyceridemia: 5 Pearls Segment [not-audio_url] [/not-audio_url]

Duration: 38:20
How quickly can triglycerides rise? At what threshold are patients at risk of pancreatitis or cardiovascular adverse outcomes? What do you have to rule out? How do you counsel on lifestyle changes? Which medications do y…
#193 Venous Congestion & VEXUS Interview with Dr. Ross Prager [not-audio_url] [/not-audio_url]

Duration: 34:44
Why is venous congestion not the same as volume overload? How can looking at IVC as well as doppler on the hepatic vein, portal vein, and/or intrarenal vein help? Can venous congestion explain someone's delirium? Or be a…
#192 Debate on First-Line Medications for Diabetes [not-audio_url] [/not-audio_url]

Duration: 36:50
SGLT-2i vs. GLP-1? vs Metformin? How do you balance the cost and coverage of first-line options like metformin, SGLT-2, and GLP-1s? How do you choose between SGLT-2 and GLP-1s for comorbidities like CAD or CKD? And how d…
#191 Hepatorenal Syndrome Part 2 on Management: 5 Pearls Segment [not-audio_url] [/not-audio_url]

Duration: 30:34
What really works when treating HRS? Vasoconstrictors like terlipressin vs. norepinephrine vs. midodrine: how do we decide which to use? Do you give albumin? When do you give Lasix or another diuretic? When is the better…
#190: Hepatorenal Syndrome Part 1: 5 Pearls Segment [not-audio_url] [/not-audio_url]

Duration: 36:11
HRS-AKI vs. other causes of AKI in cirrhosis: What do serum or urine sodium clues, albumin challenges, and shifting diagnostic criteria actually reveal about getting the diagnosis right?🔹 Sponsor: Oakstone CMEUse the cod…
#188 Orthostatic Hypotension Part 2: Gray Matters Segment [not-audio_url] [/not-audio_url]

Duration: 35:35
Medications for orthostatic hypotension! When to initiate treatment, how to use them safely, and what to do when new issues arise during treatment. How do those change if someone has autonomic failure? What do you do whe…
#187 Orthostatic Hypotension Part 1: Gray Matters Segment [not-audio_url] [/not-audio_url]

Duration: 37:20
Learn specific, practical ways to counsel patients on non-pharmacologic interventions. What is our goal with OH treatment? Is it the blood pressure number that matters? How do we avoid missing neurogenic causes of orthos…
#186 Pneumothorax: 5 Pearls Segment [not-audio_url] [/not-audio_url]

Duration: 37:03
Next time you’re squinting at a chest tube, feel confident you know exactly what to look for and why. Hear it explained in a way that really sticks!🔹 Sponsor: Oakstone CME’s ACP MKSAP Audio CompanionUse the code "CORE30"…
#185 Neutropenia: 5 Pearls Segment [not-audio_url] [/not-audio_url]

Duration: 42:21
How do you work up neutropenia? When is neutropenia benign? When do neutrophils recover? How can you diagnose neutropenic fever in the first 15 minutes and start antibiotics in the first 60 minutes? Do you always add MRS…