Point-of-Care-Ultrasound in the Evaluation of AKI with HAGMA: A Case Report

Authors: Dr Himanshu Gul Mirani, Dr Pradeep Konakanchi

A 75-year-old male presented with reduced urine output and systemic unwellness. Initial investigations revealed high anion gap metabolic acidosis (HAGMA) without history of fluid loss, new medications, or significant ketosis; lactate was mildly elevated (2.5 mmol/L), insufficient to explain the metabolic derangement (base excess −9). This raised suspicion for uremia as a cause. Point-of-care ultrasound (POCUS) was performed, which demonstrated bilateral hydronephrosis and echogenic mass within the urinary bladder with dependent sediment. The patient was catheterized and treated with antibiotics for possible associated cystitis. Subsequent CT imaging confirmed a bladder lesion suspicious for malignancy as the underlying etiology of obstruction. This case highlights the utility of POCUS in the rapid evaluation of acute kidney injury (AKI), especially when conventional causes such as hypovolemia, nephrotoxins, or sepsis are not apparent. POCUS enabled timely diagnosis and directed further management.