A few years after launching our POCUS program, we published a proposed model curriculum in 2019, drawing on our early experience and outlining suggested scan numbers for minimum competency in basic applications. If you haven’t seen the updated version, it appeared in Kidney360 in 2021 and includes helpful additions like advanced applications we teach, billing codes, sample evaluation forms, and more. [Check it out here].

However, there’s still no universally accepted curriculum or guideline. The main challenge? We haven’t reached consensus on what sonographic skills nephrologists should prioritize. Some lean toward mastering comprehensive renal ultrasound with billing and interpretation approaches similar to radiology plus vascular access and procedural guidance. Others emphasize focused, diagnostic applications that support bedside decision-making, as an extension of the physical exam. And then, there are those who believe clinician-performed ultrasound doesn’t belong in nephrology at all.

Personally, I fall firmly into the diagnostic POCUS camp. Here’s why:

Renal Ultrasound: As nephrologists, it’s essential for us to know how kidneys appear on ultrasound and be able to identify common abnormalities. The kidney is relatively straightforward to image, and the range of potential pathologies is limited, which makes both comprehensive and focused approaches valuable. A focused exam isn’t an ‘incomplete’ one, it simply means you have a specific question in mind that you’re aiming to answer through ultrasound.

Volume status assessment: Let’s call it what it really is – hemodynamic assessment. And honestly, this might be the single most useful application of POCUS in everyday practice. We’ve all been there: a patient shows up with fluid issues, and suddenly it’s a tug-of-war over volume status, especially when you find yourself in a polite standoff with cardiology 🙂 But here’s the thing: without objective bedside tools, our take on whether someone is “dry” or “wet” is still just an educated guess!

If we, as nephrologists, want to excel in this area, we need to go beyond just the IVC. We have to understand the full circuit: the pump (heart), the pipes (vasculature), and the leaks (effusions). That means getting comfortable with cardiac and lung ultrasound, plus knowing how to use IVC assessment + venous Doppler in the right context.

Scroll down to check out the figure at the end of this post: it ties it all together and shows how Doppler parameters help us answer real-time questions at the bedside. And next time someone says Nephrology POCUS is just lung or IVC, feel free to send them this.

Dialysis access: For non-interventionalists, its value lies in checking new fistulas or grafts in clinic, potentially avoiding a trip to radiology. Also aids in the evaluation of high output cardiac failure due to high-flow fistulas.

Procedural guidance: Using ultrasound to guide dialysis catheter placement is already standard. Kidney biopsy is trickier – training varies and are done by interventional radiology in a lot of programs. But if fellows are learning biopsies, they should also learn to use POCUS for marking or real-time guidance.

There’s a lot more to say on this, but I’ll save that for future posts. Stay tuned.